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An unusual complication of silver nitrate treatment of hemorrhagic cystitis: case report.

A patient with severe cyclophosphamide cystitis was treated with intravesical silver nitrate instillation to control bleeding. This resulted in apparent reflux and extravasation of the silver nitrate solution with secondary retroperitoneal inflammation. Subsequently, the patient required treatment for a small, fibrotic bladder with persistent reflux. The precautions and recommendations for treatment of such difficult patients are discussed.

Child, Preschool↗

Danazol-induced cystitis: an undescribed source of hematuria in patients with hereditary angioneurotic edema.

From 1975 through 1983, 69 patients with hereditary angioneurotic edema were treated with danazol, a semisynthetic anabolic steroid. Hematuria developed in 13 of these patients (19 per cent). Careful evaluation of the genitourinary tract showed the presence of a distinct form of hemorrhagic cystitis in 10 patients. Clinically, 9 patients presented with microscopic and 1 with intermittent gross hematuria. Irritative bladder symptoms were reported by 2 patients. Neither the dose nor duration of danazol therapy correlated with the severity of the cystoscopic or pathological findings. Cystoscopically, a rather nonspecific pattern of erythema, submucosal telangiectasia and neovascularity was observed. Histopathologically, bladder biopsy typically showed numerous dilated submucosal vessels with hemorrhage, mucosal ulceration and occasional inflammatory cells. These changes regressed in all but 1 patient when danazol therapy was discontinued. Further studies are needed to elucidate the role of danazol itself or of the danazol-hereditary angioneurotic edema interaction in the pathogenesis of these abnormalities.

Adult↗

Xanthogranulomatous cystitis.

Xanthogranulomatous lesions have been reported in many anatomical sites but only 10 cases involving the bladder have been described, 7 of which were associated with urachal adenoma. To our knowledge, we report the first instance of xanthogranulomatous cystitis in the English literature.

Adult↗

A clinicopathological and virological study of interstitial cystitis.

We studied 41 patients with chronic interstitial cystitis. Histological examination of bladder lesions revealed mucosal ulceration, pancystitis and perineural inflammatory infiltrates. Perineural cell infiltration is related probably to the characteristic symptoms of the disease. A search for a viral etiology, particularly herpes simplex virus, rendered negative results.

Adult↗

The use of sodium 2-mercaptoethane sulfonate to prevent cyclophosphamide cystitis.

In 2 patients receiving bone marrow transplantation sodium 2-mercaptoethane sulfonate has proved efficacious in preventing the serious problem of cyclophosphamide cystitis by regional detoxification of acrolein. We detail the first use of sodium 2-mercaptoethane sulfonate in the United States. We are cautiously enthusiastic and optimistic that the simultaneous administration of sodium 2-mercaptoethane sulfonate and cyclophosphamide will decrease if not eliminate cyclophosphamide-induced carcinoma.

Bone Marrow Transplantation↗

Antibody-dependent cytotoxicity to transitional cells in cystitis cystica.

Serum from 20 children with urinary tract infections and proved cystitis cystica has been examined for antibody to a panel of established cell lines derived from normal urothelium and transitional cell carcinomas of the bladder. Antibody-dependent cytotoxicity was measured with serial dilutions of patient serum and lymphocytes from normal healthy adults as effector cells. The reaction was quantitated by the release of 51chromium from labeled target cells. The patients were grouped according to the duration of symptoms, the presence or absence of reflux, and the presence or absence of upper tract changes or scarring. No differences between test and control subjects were detected.

Antibodies↗

Fungal cystitis: awareness, diagnosis and treatment.

We report 4 cases of fungal cystitis. All patients had severe urgency, frequency and nocturia with sterile pyuria and microhematuria. Significant fungal growth was observed on routine blood agar cultur. Bladder biopsy was necessary to rule out tumor. Of the patients none responded to watchful waiting, 1 responded to intermittent daily bladder instillation of amphortericin B, 2 improved with oral 5-fluorocytosine, in addition to amphotericin B bladder instillations, and 1 required intravenous amphotericin B after unsuccessful response to 5-fluorocytosine and amphotericin B bladder treatments.

Amphotericin B↗

Urinary prostaglandin E2 in acute bacterial cystitis.

The levels of prostaglandin E2 were studied in the urine of 14 female patients with acute bacterial cystitis. Ten healthy female students served as a control group. Results indicated a significant increase of urinary prostaglandin levels with a consistent relationship to the onset and duration of the clinical symptoms.

Acute Disease↗

Emphysematous cystitis associated with Clostridium perfringens bacteremia.

Anaerobes are recognized rarely as the cause of urinary tract infection. A case is reported in which there were clinical signs of sepsis, positive blood culture for Clostridium perfringens and radiographic demonstration of emphysematous cystitis without any other recognized source of infection.

Adult↗

Cyclophosphamide hemorrhagic cystitis requiring urinary diversion.

Hemorrhagic cystitis secondary to cyclophosphamide is a well recognized and unique urologic complication of this widely used agent. Cessation of the drug and supportive care are usually sufficient for management but refractory cases are difficult to treat and potentially life-threatening. A review of the pathology and treatment of this disorder is presented with specific reference to a patient requiring urinary diversion.

Adult↗

Interstitial cystitis: a chronic pelvic pain syndrome.

Interstitial cystitis, an enigmatic chronic pelvic pain syndrome that occurs primarily in women, is much more common than originally believed. Its etiology is unknown, its evaluation and diagnosis remain controversial, and its treatment is largely empiric. Recent basic and clinical research is unlocking some of the mystery surrounding this clinical syndrome. Diagnostic awareness, willingness to consider recently studied therapies, and reasonable therapeutic expectations on the part of both the physician and the patient seem to be the key to successful management of this condition.

Chronic Disease↗

Percutaneous sacral third nerve root neurostimulation improves symptoms and normalizes urinary HB-EGF levels and antiproliferative activity in patients with interstitial cystitis.

OBJECTIVES: A highly effective treatment for interstitial cystitis (IC) remains elusive. We determined whether sacral third nerve root (S3) percutaneous neurostimulation (PNS) might be effective in relieving symptoms of IC, as well as in normalizing urinary factors that are specifically altered in IC. METHODS: Six consecutive patients with symptoms and cystoscopic findings compatible with IC underwent 5 days of continuous S3 neurostimulation by way of leads placed percutaneously into the S3 foramen. Patients filled out voiding frequency diaries and pain and urgency questionnaires before PNS and at the end of PNS when the leads were removed. Urine specimens were collected at these two time points and measured for heparin-binding epidermal growth factor-like growth factor (HB-EGF) by enzyme-linked immunosorbent assay and for antiproliferative factor (APF) activity by (3)H-thymidine uptake by normal human bladder urothelial cells. RESULTS: S3 PNS significantly improved all measured parameters toward normal values. Voiding frequency decreased twofold from 23.1 +/- 4.6 to 10.6 +/- 4.0 voids daily during PNS (P = 0.0001). Pelvic pain on a scale of 1 to 10 decreased from 7.0 +/- 1.6 to 2.3 +/- 3.2 (P = 0.05). Urinary urgency on a scale of 1 to 10 decreased from 6.0 +/- 2.2 to 1.8 +/- 1.7 (P = 0. 02). Urinary HB-EGF concentration increased sevenfold from 1.5 +/- 2. 1 to 11.0 +/- 1.7 ng/mL (P <0.0001), and urinary APF activity decreased from -76.1% +/- 31% to -4.5% +/- 8.8% (P = 0.005). CONCLUSIONS: S3 PNS significantly decreased symptoms and normalized urinary HB-EGF and APF activity in patients with IC. These results suggest that permanent S3 PNS may be beneficial in treating IC.

Cell Division↗

Significance of hematuria in patients with interstitial cystitis: review of radiographic and endoscopic findings.

OBJECTIVES: Hematuria may be found in up to 30% of patients with interstitial cystitis (IC). However, few studies have described its etiology based on the findings of a complete evaluation. We reviewed the clinical significance of hematuria in the setting of IC. METHODS: We retrospectively reviewed the records of 148 patients fulfilling the National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases inclusion criteria for IC. Patients with gross or microscopic hematuria were identified. Evaluation consisted of urine culture and cytology, cystoscopy, and intravenous urography (or retrograde pyelography plus renal ultrasound). Patients with urinary tract infections were excluded. RESULTS: Of 148 patients, 60 (41%) were found to have had at least one episode of hematuria during a mean follow-up of 18 months. Of 56 patients who agreed to be evaluated, 8 (14%) had positive urologic findings. Of these, none were highly significant; five were simple renal cysts (8.9%), one was a renal stone (1.8%), one was reflux nephropathy (1.8%), and one was medullary sponge kidney (1.8%). Cystoscopy, cytology, and bladder biopsy did not demonstrate malignancy in any patient. No statistically significant differences were found in age (49.9 versus 46.7 years), sex (90% versus 91% female), bladder capacity (792 versus 808 mL), and the presence of Hunner's ulcers (5% versus 2.4%), glomerulations (60% versus 59.9%), or detrusor mastocytosis (55% versus 47.6%) between patients with hematuria and those without (P >0.05). CONCLUSIONS: The incidence of hematuria in patients with IC may be higher than previously reported. Nevertheless, although many of these patients present with pelvic pain and irritative voiding symptoms, the hematuria evaluation is unlikely to reveal a life-threatening urologic condition.

Adult↗

Intravesical potassium sensitivity in patients with interstitial cystitis and urethral syndrome.

OBJECTIVES: To examine populations with diagnosed clinical interstitial cystitis (IC) and urethral syndrome and normal controls using the potassium sensitivity test (PST), to determine the incidence of PST-provoked pain and/or urgency, and to document the type and location of IC and urethral syndrome pain, association of pain with sexual intercourse, and family history of female urgency/frequency problems. METHODS: The PST and a questionnaire were administered to 466 patients with clinical IC, 116 patients with urethral syndrome, and 42 controls. RESULTS: The PST was positive in 78% of patients with clinical IC, in 55% of patients with urethral syndrome, and in 0% of the controls. Of the patients with clinical IC, 9% responded to the PST with pain only and 8% with urgency only. Patients with clinical IC reported the pain as dysuria (58%), urethral/vaginal (76%), above the pubic bone (53%), lower abdomen (47%), lower back (35%), vaginal (51%), and inguinal (28%). The results were similar for patients with urethral syndrome. Of the sexually active men and women, 71% with clinical IC and 59% with urethral syndrome reported pain associated with intercourse. Urgency/frequency problems in female relatives were reported by 35% of patients with IC and 33% of those with urethral syndrome. CONCLUSIONS: The significant potassium sensitivity in both patients with clinical IC and those with urethral syndrome and the absence of potassium sensitivity in normal controls indicates that a positive PST suggests the presence of an abnormal bladder epithelium. The lower rate of positive PSTs in patients with urethral syndrome reflects the less severe, more intermittent, nature of the symptoms in urethral syndrome (early IC). Pelvic pain of bladder origin may occur anywhere in the pelvis. Finally, IC appears to have a genetic component.

Adult↗