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PubMed1997

Electromotive drug administration of lidocaine and dexamethasone followed by cystodistension in women with interstitial cystitis.

Electromotive drug administration (EMDA) involves the active transport of ionized drugs such as lidocaine by the application of an electric current. Twenty-one female subjects with interstitial cystitis were treated with EMDA of lidocaine and dexamethasone, followed by cystodistension. The procedure was convenient and well tolerated, with hospital attendance for 1 hour. Bladder anesthesia was excellent, with cystodistension from a discomfort level of 200 ml to a mean volume of 600 ml. Eighty-five percent had a good response (reduction in frequency and in pain score by 3 or more) at 2 weeks, with 63% still responding at 2 months. An excellent response (pain score of 0) was present in 25% of patients reviewed at 6 months. These results are comparable to the response following cystodistension under general anesthesia. There is a need for a randomized blinded comparison of lidocaine with and without EMDA. If proven to be of pharmacological efficacy, EMDA would have many applications in facilitating procedures previously requiring general anesthesia.

Administration, Intravesical↗
PubMed1997

Pentosanpolysulphate for interstitial cystitis.

Interstitial Cystitis (IC) is a chronic disease of unknown etiology which primarily affects women aged 40-60 years. Many plausible theories for the development of IC have been postulated, and one current theory is that these patients have a quantitative and qualitative defect in the glycosaminoglycan (GAG) layer of the urothelium. Such a defect may allow toxic substances in the urine to gain access to the lamina propria and initiate a chronic inflammatory process. Pentosanpolysulphate (PPS) is a sulphated proteoglycan similar in structure to heparin sulphate, which is quantitatively the major GAG on cell surfaces. Exogenously administered PPS has been shown in several studies to decrease bladder pain and urinary frequency and to increase the voided volume. Further studies are required to evaluate the role of PPS in the management of IC patients, with particular emphasis on dosage, route of administration and combination with other compounds.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2004

Clinical investigation on the correlation between lower urinary tract infection and cystitis glandularis.

In order to study the association between lower urinary tract infection and cystitis glandularis (CG), 120 cases of CG were diagnosed by cystoscopic biopsy in the suspicious foci of the bladder. Among them, 72 cases were subjected to bacterial counting culture of urine and microscopic examination of urinary sediment, and 60 cases to fluorescence quantitative polymerase chain reaction (FQ-PCR) assay to detect HPV, CMV and HSV DNA in urine samples. In the 72 cases of CG, the positive rate of bacterial counting culture of urine was 15.3% (11/72), and gray zone rate was 18.1% (13/72). 31.9% (23/72) patients were positive in bacterioscopy of urinary sediment. There was statistically significant difference as compared with the control group (P<0.01). Only 4 of 60 urine samples were positive by FQ-PCR in detection of the three viruses mentioned above with the positive rate being 6.67%. Compared with the control group, there was no significant difference (P>0.05). It was concluded that the genesis of CG was closely correlated with the chronic lower urinary tract infection, especially caused by Esch coli.

Adult↗
PubMed1987

Diagnosis of cystitis glandularis.

Bladder tumor mass may represent a benign lesion and the diagnosis of cystitis glandularis should be considered and cystoscopically evaluated.

Adult↗
PubMed1987

Alkaline encrusting cystitis.

A case of alkaline encrusting cystitis is presented, with unusual but characteristic calcifications on plain x-rays and computed tomography. These disappeared completely after adequate treatment.

Aged↗
PubMed2001

Interstitial cystitis: a chronic inflammatory bladder condition.

Interstitial cystitis (IC) is a chronic inflammatory condition of the bladder wall, characterized by urinary frequency and urgency, and severe suprapubic and/or pelvic pain. Symptoms of IC resemble those of ordinary urinary tract infections. However, standard urine cultures are negative and antibiotic therapy offers no relief. Recent research indicates that IC may be much more common than was previously thought, affecting over 700,000 people in the US. More than 90% of those affected are women, many of whose lives are thoroughly disrupted by severe pain. Long overlooked and misdiagnosed, IC is only now beginning to be understood. Although there is no specific diagnostic test or marker for IC and no uniformly effective treatment, little more than a decade of research has yielded promising results. New diagnostic tests are currently being developed and new therapeutic modalities are in clinical trials. While science searches for answers to this devastating disease, patients living with pain deserve relief.

Cystitis, Interstitial↗
PubMed2004

[Interstitial cystitis. Current aspects of diagnosis and therapy].

Interstitial cystitis is a chronic, heterogeneous syndrome that is characterized by the classic symptoms of bladder pain, nycturia, and pollakiuria. Population studies have shown an increase in prevalence and incidence. Different hypotheses exist about the etiology and pathogenesis. Epithelial dysfunction and neuro-urothelial interaction are the most frequently used causal models. Utilization of the official diagnosis criteria of the NIDDK (National Institute of Diabetes, Digestive and Kidney Disease) should be flexible and individual in order not to overlook early forms of IC. Since there is no pathognomonic marker, diagnosis of IC is a combination of typical patient history and exclusion of differential diagnoses. Cystoscopy and biopsies are not specific; however, they can provide useful information on extent and aid in treatment choice. The effectiveness of conservative therapy has been increased by using electromotive drug administration (EMDA) in instillation therapy.

Causality↗
PubMed2006

[Interstitial cystitis. An important differential diagnosis].

Interstitial cystitis (IC) is a chronic, debilitating inflammatory disease of the urinary bladder, characterized by chronic pelvic pain, urgency/frequency symptoms, and decrease of the functional bladder capacity. Both the etiology and pathogenesis of the condition that predominantly affects women are still not fully understood. Thus, a causal therapeutic approach still does not exist. IC remains a strict diagnosis of exclusion; distinct histopathological findings within the bladder wall are frequently found, although they are not pathognomonic. The diagnostic criteria elaborated by the NIH are helpful in clinical research; their dogmatic utilization will however lead to an underdiagnosis of IC in 60% of the patients. IC-specific symptom questionnaires and validated symptom scales help the physician to assess the therapeutic response during the follow-up of the patients.

Administration, Intravesical↗
PubMed2007

[Cystitis emphysematosa--a case report].

We present a rare case of cystitis emphysematosa in an 85-year-old female patient in whom the typical risk factors were present: diabetes of long standing, neurogenic bladder and urinary infection with E.coli. Thanks to early diagnosis by cystoscopy and abdominal CT, after antibiotic treatment, appropriate insulin therapy and continuous bladder drainage the course was uneventful. The patient was fit to leave hospital after 14 days.

Aged, 80 and over↗
PubMed2007

[Intravesical cidofovir--instillation therapy for polyomavirus-associated hemorrhagic cystitis after bone marrow transplantation].

Viral infections of the urogenital tract are a potential problem in patients taking immunosuppressive medication. We report a 14 year old male patient with hemorrhagic cystitis who had undergone bone marrow transplantation for the treatment of acute lymphoblastic leukemia. Attempts at coagulation as well as instillation treatment and continuous bladder irrigation were not sufficient to stop bleeding. Sequential to these procedures, local instillation with cidofovir into the bladder was started to treat a suspected infection with polyomavirus and the gross hematuria stopped within a few days.

Administration, Intravesical↗
PubMed2000

[Epidemiology of interstitial cystitis].

Available data on the epidemiology of interstitial cystitis (IC) are heterogeneous. Its prevalence ranges between 16 and 510 females/100,000 inhabitants and the incidence at 1.2-2.6/100,000 females with a mean age of 42-52 years. The disease tends to affect women (female:male ratio 9-10:1) and Caucasians (> 90%). The quality of life of patients suffering from IC is reduced to a significant degree in almost every aspect (work, social events, leisure activities). Financial expenses (medical as well as economical) associated with the disease are considerable. There is an enormous need to promote IC education and research in order to support affected patients effectively in the future.

Adult↗
PubMed2000

[Diagnosis of interstitial cystitis].

Interstitial cystitis (IC) represents a rare and complex inflammatory bladder condition in which diagnostics can be challenging. Strict NIH criteria for its diagnosis were designed for research purposes. Their routine application would miss large proportions of IC patients. When IC is suspected, history and physical exam are followed by an evaluation of long-term voiding diaries. Large voided volumes (functional capacity > 250 cc) or longer micturition intervals (> 2 h.), absence of nocturia or symptom-free periods reduce the likelihood of IC. Further exclusion diagnostics include urine tests (infection), cytology (in-situ carcinoma), ultrasound (calculi, bulks, anomalies) and urodynamics in selected cases. Bladder capacity measurements under sedoanalgesia are of limited value, since functional low-volume bladders can be mechanically extendable. Cystoscopy under general anesthesia represents the diagnostic standard procedure for IC during which 90% of IC-patients present with characteristic mucosal glomerulations after bladder distension. Biopsies are recommended for exclusion of malignancy. Potassium-leak testing plays no relevant role in routine diagnostics due to its poor sensitivity. Similarly, complex determinations of novel IC markers (histamine, tryptase, cytokines, growth factors, substance P, nitric oxide) are of no relevance in clinical settings and should be restricted to research projects.

Biopsy↗
PubMed2000

[Oral therapy of interstitial cystitis].

Up to now there is no specific treatment targeting the ultimate cause of interstitial cystitis (IC), since its pathogenesis and etiology are still unknown. Most studies focussing on oral medication have not been randomized, double-blinded or placebo-controlled. Numerous case reports and intent-to-treat trials are lacking a systematic approach and do not meet evidence-based medicine criteria. Consequently there is as yet no standard oral therapy available for the treatment of IC. However, only a few oral substances have shown a potential to improve symptoms such as frequency and pain. The best results were obtained from monotherapeutic use of pentosanpolysulfate, amitriptylin and hydroxycin. The true benefit of these substances alone should be compared to analgesics and anticholinergics in the course of controlled clinical trials.

Administration, Oral↗
PubMed2000

[Alternative and complementary therapeutic measures in interstitial cystitis].

Alternative therapies are gaining more and more popularity. Mostly, these methods are demanded by patients who are not effectively relieved by allopathy. This review points out alternative and additive methods that have been repeatedly described as effective as additional supportive treatments of interstitial cystitis.

Complementary Therapies↗
PubMed2003

Sacral neuromodulation for the treatment of refractory interstitial cystitis: outcomes based on technique.

Patients with refractory interstitial cystitis (IC) underwent testing with sacral nerve modulation via either a traditional percutaneous approach or a staged procedure. Implanted patients were followed with scaled questionnaires and voiding diaries. Twenty-six patients who had a permanent InterStim placed had a reduction in 24-h voids of 51%. More than two-thirds of patients reported a moderate or marked improvement in urinary frequency, urgency, pelvic pain, pelvic pressure, incontinence and overall quality of life. The test to implant rate of a traditional percutaneous procedure was 52%, compared to a staged procedure of 94%. Assessing sensory response at the time of implant reduced the reoperation rate from 43% to 0%. Ninety-six per cent stated they would undergo an implant again and recommend the therapy to a friend. We concluded that sacral nerve modulation can treat refractory IC symptoms. The response to therapy and the reoperation rate are dependent on the technique used to test and implant the device.

Adolescent↗
PubMed2004

Different clinical presentation of interstitial cystitis syndrome.

The aim of the study was to examine how interstitial cystitis (IC) initiates its clinical course, which changes as the disease progresses from the initial phase to its full clinical manifestation. Patients diagnosed with IC between 1998 and 2003 in our department were evaluated and reviewed regularly. The exact onset of urinary symptoms was recorded. Diagnosis of IC was made by National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) criteria when clinical suspicion of IC was present. The study group included 30 female patients who were 27-69 years old when diagnosis was made. Mean age was 46.7. Seventy percent of patients had only one symptom at onset. The most frequent initial diagnosis was urinary tract infection (UTI). A condition of recurrent bacterial UTIs, with subsequent persistence of symptoms and negative cultures, could be detected as a harbinger of IC in 60% of our patient group. IC may manifest initially with a single symptom in its early stage, when diagnosis is perhaps less easy, but adequate and effective treatment can still be offered to the patient.

Adult↗
PubMed2005

Sexual function after partial cystectomy and urothelial stripping in a 32-year-old woman with radiation cystitis.

We report a case of a 32-year-old woman who underwent a partial cystectomy to preserve sexual function. After radiotherapy for stage IB1 cervical cancer, cystectomy was indicated because of severe radiation cystitis. During this procedure we resected the upper part of the bladder followed by stripping off urothelium of the remaining bladder to spare the neurovascular bundle. Follow-up after 3 months indicated intact sexual function including orgasm. In our opinion the cystectomy procedure described in this case report is a good, novel option in women who are candidates for cystectomy because of a crippled bladder, after radiotherapy, and want to retain sexual function.

Adult↗