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PubMed2001

Aspergillus species cystitis in a cat.

A Persian male cat with a history of lower urinary tract disease was presented because of polydipsia, polyuria, constipation and nasal discharge. Ten weeks before admission, the cat had been treated for lower urinary tract disease by catheterisation and flushing of the bladder. The animal was thin, dehydrated, anaemic and azotaemic. Urine culture revealed Aspergillus species cystitis. Antibodies against Aspergillus nidulans were identified in serum. Fluconazole was administered orally (7.5 mg/kg, q 12 h) for 10 consecutive weeks. The azotaemia was resolved, the kidney concentrating ability was recovered and the cat has remained healthy without similar problems.

Animals↗
PubMedDate not supplied

Lumbar sympathetic block for pain relief in two patients with interstitial cystitis.

BACKGROUND AND OBJECTIVES: Interstitial cystitis (IC) is characterized clinically by lower abdominal pain, pain during urination, and increased frequency of urination. Treatment of the symptoms in IC remains challenging. We report effective treatment using lumbar sympathetic block for 2 patients with IC. CASE REPORT: A 63-year-old and 78-year-old woman were diagnosed with IC. Medical therapy with nonsteroidal anti-inflammatory drugs (NSAID), anticholinergics, and hydrodistention of the bladder failed to improve their symptoms. Subsequently, a continuous lumbar epidural block using 1% mepivacaine was used in these patients. A transient reduction of the symptoms in both patients was achieved. A lumbar sympathetic block with a neurolytic agent produced almost complete, and long-lasting relief of their symptoms. CONCLUSION: Lumbar sympathetic block using a neurolytic agent produced long-lasting pain relief in 2 patients with IC. Reg Anesth Pain Med 2001;26:271-273.

Aged↗
PubMed2005

Haemorrhagic cystitis as a complication after allogenic bone marrow transplantation.

OBJECTIVE: The main objective of the following work is to present our own material and the ways in which we have dealt with haemorrhagic cystitis (HC) following allogenic bone marrow transplantation in children. MATERIALS AND METHOD: From 1994 to 2002, allogenic transplantation of haematopoietic cells was performed in 129 children at the Oncological and Haematological Child Clinic, Wroclaw University of Medicine. The procedure was carried out in patients with neoplastic diseases. In 33 cases, HC symptoms of various intensity were observed. The intensity of the symptoms was evaluated according to Arthur's four-point scale. To confirm the diagnosis USG was carried out in each case. Special attention was given to the ultrasonographic structure of the bladder wall. Cartoni's technique was followed in the examination. RESULTS: Out of 129 children who underwent allogenic transplantation of haematopoietic cells 33 (20.75 %) revealed HC symptoms. The symptoms occurred between the 2nd and the 124th day after transplantation (mean 29 days). The treatment included antiviral medicines, estrogens, reduction of immunosuppression and mechanical urological procedures. The children diagnosed with 2nd grade disease and higher were catheterised and diuresis was forced by the administration of larger amounts of liquids intravenously. Antihaemorrhagic drugs and vitamin K were also given. Blood was substituted if needed as were blood derivatives. Eighteen children with massive haematuria with clots underwent catherisation with a suprapubic catheter so as to continuously rinse the bladder. In 8 cases tamponade of the bladder occurred. The clots were removed from the bladder during cystoscopy under general anaesthesia. Twelve children died from HC. This amounts to 36 % of all the cases identified as HC and 9 % of all the children who underwent allogenic marrow transplantation. CONCLUSIONS: In conclusion it must be emphasised that HC in children after allogenic transplantation of haematopoietic cells is an extremely severe disease, which, if not cured, is terminal. The decision whether to perform embolisation of internal iliac arteries or to remove the bladder when non-radical methods have been exhausted, is worth considering.

Bone Marrow Transplantation↗
PubMed1983

[One-time therapy of acute cystitis in women. Comparison between gentamycin and amoxicillin].

In a randomized trial 65 women with symptoms of acute cystitis and significant bacteruria were treated with 120 mg gentamycin intramuscularly or 3 g amoxicillin orally. The patients were selected by excluding those with recurrent infection and involvement of the upper urinary tract (by history and clinical examination). The urine was sterile in 53 patients (82%) after a one-week treatment-free interval. The results indicate that there was no statistically significant difference between the two treatment groups. Further diagnostic tests revealed an underlying urological disease in five of the 12 remaining patients.

Acute Disease↗
PubMed2006

CKAP4/p63 is a receptor for the frizzled-8 protein-related antiproliferative factor from interstitial cystitis patients.

Antiproliferative factor (APF) is a low molecular weight sialoglycopeptide that is secreted by bladder cells from interstitial cystitis patients and is a potent inhibitor of both normal bladder epithelial and bladder carcinoma cell proliferation. We hypothesized that APF may produce its antiproliferative effects by binding to a transmembrane receptor. This study demonstrates that cytoskeleton-associated protein 4/p63 (CKAP4/p63), a type II transmembrane receptor, binds with high affinity to APF. The antiproliferative activity of APF is effectively inhibited by preincubation with anti-CKAP4/p63-specific antibodies, as well as by short interfering RNA knockdown of CKAP4/p63. Immunofluorescent confocal microscopy showed co-localization of anti-CKAP4/p63 and rhodamine-labeled synthetic APF binding in both cell membrane and perinuclear areas. APF also inhibits the proliferation of HeLa cervical carcinoma cells that are known to express CKAP4/p63. These data indicate that CKAP4/p63 is an important epithelial cell receptor for APF.

Amino Acid Sequence↗
PubMed1984

Urinary tract infection during pregnancy. Asymptomatic bacteriuria, acute cystitis, and acute pyelonephritis.

Urinary tract infection is one of the most common medical complications of pregnancy, occurring in roughly 10% of all pregnancies. The clinical entities most commonly seen are bacteriuria, acute cystitis, and acute pyelonephritis. Relative stasis of urine due to pregnancy-induced changes in the urinary tract is a significant causative factor. Escherichia coli is the most common responsible organism. Patients with untreated or inadequately treated asymptomatic bacteriuria are at high risk for development of acute pyelonephritis, a serious febrile illness that can lead to major maternal and fetal complications. Patients with acute pyelonephritis should be hospitalized and treated aggressively.

Acute Disease↗
PubMed2004

Urine analysis and decision-making on cystitis in general practice.

Decision-making on cystitis in general practice was studied by addressing 1171 general practitioners of whom 909 responded. A case history was supplied with a test-strip result where leucocyte esterase was 1 + and the nitrite field either positive or negative. The respondents' estimated probability of urinary tract infection from the history had a median at 50% (10 and 90 percentiles, 30% and 90%). The test-strip results changed the estimate to 90% (50% and 100%) in the nitrite-positive group and 50% (10% and 90%) in the nitrite-negative group. Likelihood ratio was calculated from each respondent's estimated pre- and post-test probability to express the test's assumed diagnostic power. The median likelihood ratios were 4.75 (10 and 90 percentiles, 1.00 and 35.70) in the nitrite-positive group and 1.00 (0.11 and 4.00) in the nitrite-negative group. The resulting actions taken by the respondents were: no action (14 respondents, corresponding median estimated post-test probability 27.5%), await further examination (482, 50%) and prescription of antibiotics (366, 90%). Further examination included urine microscopy (13%), bacteriologic culture (21%), or both (65%). Eight-two percent of respondents who decided to prescribe antibiotics would also perform further examinations. In routine urine analysis, 79% of respondents request only test strips, 2% perform microscopy and 19% do both. The estimated probability of urinary tract infection is significantly affected by test-strip results and is important for the choice of further actions. Microscopy is performed more often than recommended in other studies.

Adult↗
PubMed2003

Cytomegalovirus-induced haemorrhagic cystitis in a patient with neurogenic bladder.

We report a case of severe cytomegalovirus induced haemorrhagic cystitis associated with neurogenic urinary bladder in a patient suffering from anaplastic spinal ependymoma. The diagnosis was established by bladder biopsy and immunohistochemical study. Haematuria resolved after ganciclovir therapy. Previous reports are reviewed.

Acute Disease↗
PubMed2003

Emphysematous cystitis.

An elderly woman with poorly controlled diabetes entered the casualty department suffering from abdominal pain. Clinical and radiological examinations revealed intramural and intraluminal gas in the urinary bladder, suggesting the diagnosis as emphysematous cystitis, a rare disorder usually caused by aerobic and not anaerobic microbes. The causal agent is often, as in this case, Escherichia coli.

Aged↗
PubMed2003

Interstitial cystitis: a review of current concepts of aetiology, diagnosis and therapy.

Until recently, interstitial cystitis (IC) has been described as a chronic clinical syndrome of obscure aetiology and, consequently, specific treatment for the condition is lacking. IC has often been regarded as a diagnosis of exclusion in women complaining of chronic pelvic pains, frequency, dysuria, etc. and until recently most clinicians rarely considered this diagnosis in men. However, recent research efforts have begun to yield vital information on this underdiagnosed and distressing clinical condition regarding its aetiology and diagnosis and, consequently, more effective therapeutic options are now emerging. The aim of this review is to highlight these emerging concepts of the aetiology, diagnosis and innovative therapy of IC, in order to help clinicians confronted by patients with this disorder.

Chronic Disease↗
PubMed2003

Intercurrent autoimmune conditions in classic and non-ulcer interstitial cystitis.

OBJECTIVE: Interstitial cystitis (IC) is known to be one of the most bothersome conditions encountered in urological practice. It is frequently divided into two subtypes: classic and non-ulcer. Several authors have reported on autoantibodies in patients with IC and clinical and histopathological findings show similarities with those in some autoimmune disorders. Furthermore, IC has been shown to be associated with autoimmune diseases such as systemic lupus erythematosus, Sjögren's syndrome and autoimmune diseases of the thyroid gland. Our aim was to study the occurrence of associated autoimmune conditions in patients with IC diagnosed according to the National Institutes of Health/National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases criteria. MATERIAL AND METHODS: Our sample of IC patients consisted of 129 with classic IC and 93 with non-ulcer IC. Clinical records, including micturition charts, were surveyed, and a more in-depth interview was obtained by means of a telephone call. Autoimmune disorders, diagnosed by Swedish clinicians according to acknowledged diagnostic criteria, were registered. RESULTS: Allergy was the most common IC-associated condition, 41% of all patients with classic IC and 47% of all patients with non-ulcer IC having some type or degree of hypersensitivity/allergy. Rheumatoid arthritis occurred in 13% of patients with classic IC and in 4% with non-ulcer IC. Inflammatory bowel disease was not diagnosed in any of the patients with non-ulcer IC whereas 2.3% of the patients with classic IC had either ulcerative colitis or Crohn's disease, approximately 33 times the prevalence seen in the general population. CONCLUSION: It appears that systemic and autoimmune disorders are more prevalent in the IC population than in the general population.

Adult↗
PubMed2005

Critical appraisal of dimethyl sulfoxide treatment for interstitial cystitis: discomfort, side-effects and treatment outcome.

OBJECTIVE: To evaluate the discomfort and long-term efficacy associated with instillation of dimethyl sulfoxide (DMSO). MATERIAL AND METHODS: A total of 28 patients, 13 (11 females, 2 males) with classic interstitial cystitis (IC) and 15 (13 females, two males) with non-ulcer disease, who had received at least one series of six instillations of DMSO were studied. In addition to studying micturition diaries before and after the treatment, the evaluation included assessments of pain using a visual analog scale and of side-effects after each instillation in every series. Data were obtained by surveying the clinical records. A follow-up telephone interview was conducted for those patients who were treated with DMSO and in whom the treatment was considered successful. DMSO instillations were considered successful if the patient reported symptom amelioration and chose to continue with the treatment. RESULTS: Side-effects were not more common or pronounced in patients with classic compared to non-ulcer IC. For classic IC a significant difference could be seen when comparing side-effects experienced during the first three instillations and the three subsequent instillations. After DMSO instillations, a residual treatment effect lasting 16-72 months could be seen. CONCLUSIONS: Intravesical instillation therapy with DMSO appears to be a feasible treatment option for both subtypes of IC and is associated with a reasonably low degree of discomfort.

Administration, Intravesical↗
PubMed1998

Decreased levels of S-100 protein in non-ulcer interstitial cystitis.

Interstitial cystitis (IC) is a chronic debilitating condition which mainly affects women. Accumulated evidence indicates that IC is a heterogeneous syndrome. As compared to classic IC, the non-ulcer type of IC appears to be different concerning symptomatic, endoscopical and histological findings, as well as in response to various forms of treatment. S-100 is a neural protein considered to be located primarily in the axons. To explore further the neurogenic nature of the disease, we compared bladder wall S-100 content in controls and in patients with classic and non-ulcer IC. We noticed a decrease in S-100 content in non-ulcer IC as compared to controls. This may be an expression of altered peripheral innervation in non-ulcer IC, which, in turn, may be an indication of primary neurogenic etiology. The difference in S-100 content between classic and non-ulcer IC supports the hypothesis that they represent separate entities, which may explain differences in response to various treatments.

Adult↗
PubMed1999

Eosinophilic cystitis--not that uncommon!

The clinical presentation, radiological manifestations and response to therapy of seven cases of biopsy-proven eosinophilic cystitis seen over an 8-year period were evaluated retrospectively. All of the five men and two women had symptoms of dysuria and frequency, with haematuria in two cases. One developed acute painful retention. The urine was sterile in all. Radiological findings included bladder mass lesions and upper tract dilatation. Cystoscopy showed papillary, erythematous and ulcerative mucosal lesions, and in one instance a large mass lesion. The various procedures carried out were cold cup biopsies, transurethral resections, or fulgration of lesions and partial cystectomy. Medical therapy included non-steroidal anti-inflammatory drugs and prophylactic antibiotics to cover the procedures carried out. There was excellent symptomatic improvement in all patients. This is the largest single-centre experience reported, and is unusual as the majority of the patients in this series were men.

Adult↗
PubMed1999

Interstitial cystitis provoked by tiaprofenic acid.

A patient developed clinical and histological interstitial cystitis as an adverse effect of treatment with tiaprofenic acid for rheumatism. After cessation of the drug, full symptomatic recovery was obtained. Bladder biopsies 6 months later demonstrated normalization of detrusor muscle histology.

Aged↗
PubMed1999

Eosinophilic cystitis--diagnosis and treatment in Denmark.

OBJECTIVE: The purpose of this study was to evaluate the incidence, diagnostic criteria and treatment of eosinophilic cystitis (EC) in Denmark during the period 1989-94. MATERIAL AND METHODS: A questionnaire was sent to all Danish departments of surgery, urology and pathology. RESULTS: Fifty-six cases of EC were diagnosed in the departments of surgery and urology, and 135 patients were diagnosed in the departments of pathology. The therapy was most often steroid instillation in the bladder or peroral antihistamines. Success rates of treatment were reported to be acceptable. CONCLUSION: The questionnaire confirmed that EC is a rare disease, which is often confused with other bladder diseases. We recommend strict histological criteria combined with clinical information when making the diagnosis of EC. Therapy is generally symptomatic. A diagnostic code number from the Danish Health Board is needed.

Cystitis↗
PubMed2004

Interstitial cystitis.

Interstitial cystitis (IC) is a debilitating chronic inflammatory disorder of the bladder. It affects predominantly middle-aged Caucasian women. The diagnosis, made from the combination of symptoms, cystoscopic findings and bladder biopsies, is often delayed in the gynaecology setting because of a low index of suspicion. The pathophysiology is incompletely understood, although mast cell activation, altered bladder epithelial permeability and sensory afferent nerve up-regulation are thought to play key roles. Recent theories include the role of an antiproliferative factor. A wide assortment of therapies is available and many more are under trial. Until the causes and pathogenesis of IC are unraveled, mainstream medical treatment will remain palliative and cystectomy with urinary diversion, the only potential cure. In addition to our long experience on managing this disorder, we present a comprehensive review of the current thoughts on the aetiology and management of IC.

Cystitis, Interstitial↗