Bladder Irritation Research Articles

Late Local Recurrence of Carcinoma <i>in situ </i>- Only Bladder Cancer

Late recurrence (LR) of bladder cancer after radical cystectomy (RC) is rare, and few studies have been conducted. We report a case of local LR of bladder cancer 10.3 years after RC. The pathology at RC was almost carcinoma <i>in situ</i> (CIS) only. The patient underwent metastasectomy, and treatment with an immune checkpoint inhibitor (ICI) achieved a complete response (CR). A 61-year-old woman was referred to our hospital for macrohematuria and bladder irritability in June 2012. She underwent RC along with pelvic lymph node dissection and ileal conduit creation. The pathologic findings were CIS, G2>G3, pT1, pN0. She visited our hospital with complaints of lower abdominal discomfort in November 2022, and recurrence was found on the pelvic floor by abdominal computed tomography. Metastasectomy confirmed metastasis of urothelial carcinoma. As salvage therapy, systemic chemotherapy with a platinum agent and an ICI were administered, leading to CR. Long-term follow-up should be considered for patients with bladder cancer, even for early-stage CIS-only tumors. Metastasectomy could be the primary option for LR of bladder cancer after RC.

Feasibility and safety of flexible ureteroscopy with intelligent control of renal pelvis pressure without urinary catheter: a retrospective study

BackgroundTo explore the feasibility and safety of aflexible ureteroscopy with intelligent control of renal pelvic pressure(FUS-ICP) without a post-operative indwelling urinary catheter .MethodsIn this retrospective study, we assessed patients with upper urinary tract stones who were treated with FUS-ICP at the Ganzhou People’s Hospital from February 2022 to December 2023. Patients were divided into the non-urinary catheter (non-UC) and urinary catheter (UC) groups according to whether an indwelling catheter was used after surgery.ResultsIn total, 142 patients were included in the study. There was no significant difference in the preoperative general data between the two groups. Patients in the non-UC group performed better than those in the UC group in terms of catheter-related bladder irritation (P = 0.001), the Sedation-Agitation Scale score (P = 0.012), and the numerical rating scale (P = 0.003). The incidences of urinary retention (P = 0.620), urinary tract infection (P = 0.529), and replacement of urethral catheter s (P = 0.438) in the UC group were inferior to those in the non-UC group, but there was no statistical significance.ConclusionsIt is feasible and safe to perform FUS-ICP without a post-procedure indwelling urinary catheter.

Prevalence and Risk Factors Associated with Benign Prostate Hyperplasia among Elderly Patients in Baidoa Hospitals in Somalia Cross Sectional Study

Background The disorder known as benign prostatic hyperplasia (BPH) is closely linked to ageing. Its clinical presentation as lower urinary tract symptoms (LUTS) lowers the patient's quality of life, despite the fact that it is not life- threatening. Among males over 65, up to 30% may experience problematic LUTS.  Objectives of the Study The aim of this study is to determine the prevalence and risk factors contributing benign prostate hyperplasia among elder patients in Baidoa hospitals in Somalia.  Materials and Methods The study design was a hospital based cross sectional study.  Results The prevalence of BPH shows that 19.01 % of the participants were becomes BPH while the remaining majority 80.99 was not. The age, the largest group is those aged 70-79 years, with 157 participants, representing 40.9%. In terms of family history of (BPH), 310 participants (80.7%) reported no family history, while 74 individuals (19.3%) indicated that they do have a family history of BPH. Examining systemic diseases, 51 participants (13.2%) have diabetes mellitus, and 67 individuals (17.3%) have hypertension. A smaller subset, 26 participants (6.7%), reported having both diabetes and hypertension. Regarding physical exercise, 310 individuals (80.7%), reported not engaging in regular physical activity, while only 74 participants (19.3%) they do exercise.  Conclusion In summary, the data and reports from this study point to a 19.01% prevalence of benign prostatic hyperplasia (BPH). The development of BPH is significantly predicted by age. Bivariate chi-square analysis revealed a significant link between BPH and erectile dysfunction, kidney illnesses, diabetes mellitus, and urine retention (p-value <0.05). On the other hand, bivariate chi-square analysis revealed a significant relationship between BPH and being overweight and frequently consuming caffeine (p-value <0.05). Diet and lifestyle could be factors in this.  Recommendations Lifestyle and behavioral interventions are reasonable first-line treatments for all patients. Straightforward interventions include limiting intake of the following: fluids prior to bedtime or travel; mild diuretics, such as caffeine and alcohol; and bladder irritants, such as highly seasoned or irritative foods. Older be aware that blocking of the urethra (the urine tube): As the prostate grows larger, it may block the bladder outlet and stop the bladder from emptying. In some cases, urine may get stored up until it starts to leak out. If this happens, see a doctor straight away, so the patients should urinate quickly before experiencing any problem.

Short-term Outcome of RPVBT Combined with Chemotherapy for Patients with Single, < 3 cm, T2 Stage Bladder cancer

BackgroundTo investigate the survival outcome of “radical” GreenLight photoselective vaporization of bladder tumor (RPVBT) in conjunction with postoperative chemotherapy for patients with single, < 3 cm in diameter, T2 stage muscle invasive bladder cancer (MIBC).MethodsThirty-eight patients with single, < 3 cm, T2 stage bladder cancer were treated with RPVBT combined with chemotherapy and were included in the RPVBT group. To compare the differences in survival outcome, 80 patients with Ta/T1 bladder cancer and 30 patients with T2 bladder cancer were included as controls. The 80 patients with Ta/T1 bladder cancer underwent GreenLight photoselective vaporization of bladder tumors(PVBT), while 30 patients with T2 bladder cancer underwent radical cystectomy (RC) combined with pelvic lymph node dissection (PLND). Tumor recurrence and death were recorded, and recurrence-free survival (RFS) and overall survival (OS) curves were plotted to compare the survival difference between the RPVBT and control groups.ResultsNo significant differences were observed in comorbidities or living habits between the RPVBT and control groups. Blood loss [RPVBT: 20 (IQR10, 20) vs. RC: 100 (IQR90, 150) mL] and postoperative hospital stay [RPVBT: 5.5 (IQR5, 6), vs. RC: 10 (IQR8, 12) days] in the RPVBT group were significantly lower than that in the RC group. Urinary tract infection [RPVBT: 6 (15.8%) vs. PVBT: 14 (17.5%)] and bladder irritation sign [RPVBT: 11 (28.9%) vs. PVBT: 23 (28.8%) ] were the most common short-term complications in the RPVBT group, with no statistical difference between the RPVBT and PVBT group. The median follow-up time for survival endpoints was 22 (16, 27) months for the included patients after surgery. The outcomes of tumor recurrence at 12, 24, and 36 months were 2 (5.3%), 3 (7.9%), and 5 (13.2%) patients in the RPVBT groups, 13 (16.3%) and 3 (10%) patients experienced recurrence in the PVBT and RC groups at 36 months. No significant differences were noted among the three groups (P = 0.778). Additionally, Kaplan–Meier survival analysis revealed no statistically significant differences in RFS (P = 0.791) and OS (P = 0.689) among the three groups.ConclusionsOur findings indicate that RPVBT combined with chemotherapy is a simple and feasible treatment option with fewer complications and satisfactory survival outcomes in patients with single, < 3 cm, T2 stage bladder cancer.

Developing a urinary incontinence primary care pathway: a mixed methods study.

While nearly 50% of adult women report at least one episode of urinary incontinence (UI), most never receive treatment. To better integrate primary and specialty UI care, we conducted (i) an environmental scan to assess the availability of key pathway resources in primary care, (ii) interviews with primary care providers to understand barriers to care, and (iii) a pilot UI care pathway intervention. Environmental scan: Clinic managers from all primary care clinics within a Midwestern healthcare system were invited to participate in an interview covering the availability of clinic resources. Provider interviews: Primary care providers were invited to participate in an interview covering current practices and perceived barriers to UI care. Pilot UI care pathway: Patients who screened positive for UI were provided resources for first-line behavioral management. Pilot patients completed questionnaires at baseline, 8 weeks, and 6 months. While many clinics had point-of-care urinalysis (17/21, 81%), most did not have a working bladder ultrasound (14/21, 67%) or on-site pelvic floor physical therapy (18/21, 86%). Providers (n = 5) described barriers to completing almost every step of diagnosis and treatment for UI. The most persistent barrier was lack of time. Patients (n = 15) reported several self-treatment strategies including avoiding bladder irritants (7/15, 47%) and performing Kegel exercises (4/15, 27%). Five patients (33%) requested follow-up care. At 6 months, patients reported small improvements in UI symptoms. Promising results from a novel UI care pathway pilot indicate that streamlining UI care may assist primary care providers in the first-line treatment of UI.

Treating BCG-Induced Cystitis with Combined Chondroitin and Hyaluronic Acid Instillations in Bladder Cancer.

In non-muscle invasive bladder cancer, Bacillus Calmette-Guérin (BCG) responders benefit from strong Th1-type inflammatory and T cell responses mediating tumor rejection. However, the corresponding lack of anti-inflammatory Th2-type immunity impairs tissue repair in the bladder wall and facilitates the development of cystitis, causing urinary pain, urgency, incontinence, and frequency. Mechanistically, the leakage of the glycosaminoglycan (GAG) layer enables an influx of potassium ions, bacteria, and urine solutes towards the underlying bladder tissue, promoting chronic inflammation. Treatments directed towards re-establishing this mucopolysaccharide-based protective barrier are urgently needed. We discuss the pathomechanisms, as well as the therapeutic rationale of how chondroitin and hyaluronic acid instillations can reduce or prevent BCG-induced irritative bladder symptoms. Moreover, we present a case series of five patients with refractory BCG-induced cystitis successfully treated with combined chondroitin and hyaluronic acid instillations.

Management of Complications from Ureteral Double-J Stents of BioradMedisys and Analysis of Risk Factors

Double-J ureteral stents of Biorad Medisys are widely used to treat urinary blockages. Early consequences with double-J stents often include pain, bladder irritation, and fever; late issues are more bothersome. We examine four instances that demonstrate a range of late problems with double-J stents (encrustation, migration, and fragmentation). Following a review of the literature, recommendations for monitoring potential risk factors are developed, as well as treatment measures for preventing problems while utilising double-J stents.

Spontaneous renal pelvis rupture: a case report

Uro-Technology Journal Home About Guidelines Current Issue Archives Online First Special Issues Editorial Board Videos Submissions Home &gt; Vol 7, No 4 (2023) &gt; Pizzarello Download PDF Submit A Manuscript Table of contents Spontaneous renal pelvis rupture: a case report Javier Pizzarello, Luis Rico, Leandro Blas, Hernando Rios Pita Abstract Spontaneous renal pelvic rupture (SRPR) is a rare entity. Diagnosis is made by contrast-enhanced computed tomography or retrograde pyelography, and management may be active or conservative. We present the case of a 79-year-old woman who developed SRPR of the left kidney on the fifth postoperative day of a right laparoscopic nephroureterectomy with endoscopic bladder cuff resection. Active management was decided and a ureteral catheter was placed. Symptoms improved and the patient did not develop any complications during follow-up. This case report explores SRPR, a condition with traumatic and non-traumatic causes, including urethral calculi and congenital abnormalities. SRPR is the result of a sudden increase in intraluminal pressure, often exceeding 20–75 mmHg, causing tissue tearing at the weakest urinary tract point, the fornix. In this instance, the patient experienced contralateral renal pelvic rupture following nephroureterectomy with no apparent cause for elevated intrarenal pressure. We propose that bladder irritation after ureteral cuff resection induced spasms, triggering the rupture. Diagnostic challenges arise as initial symptoms mimic renal colic, later manifesting as a urinoma. Imaging techniques, such as ultrasonography and contrast-enhanced CT, aid in the diagnosis. Treatment options encompass ureteral stenting and conservative management, with the choice depending on the patient’s condition. This case underscores the significance of early recognition and management of SRPR, especially following nephroureterectomy. In conclusion, SRPR is an entity that requires immediate management. It is important to evaluate if there are any features that require active treatment.

Radiological image analysis of double J tube in ureteral calculus operation for clinical evaluation and nursing procedures

ObjectiveTo explore the effect of radiological imaging and continuous care in patients with double-J ureteral calculi (URL) after indwelling double-J tube. MethodsUreteral calculus is a common clinical stone disease, often cause obvious abdominal pain, and can radiate to the groin and medial thigh. After operation for ureteral calculi, some patients will be discharged with double J tube. 68 patients with double J tubes of ureteral calculi treated in our hospital were selected as research objects, and were divided into control group and observation group by lottery. The control group received routine nursing intervention, and the observation group received continuous nursing based on routine nursing intervention. The incidence of circuit-related complications, self-care ability, and quality of life were compared between the two groups. ResultsThe patients in the observation group had significantly lower occurrences of pipeline shedding, hematuria, and bladder irritation than those in the control group (P < 0.05). The self-care ability scores of the observation group at discharge were higher than those of the control group at admission, the comparison was statistically significant (P < 0.05). The quality-of-life scores of patients in the observation group were higher than those in the control group (P < 0.05) in terms of mental health, physical function, and general health. ConclusionMost of the positive ureteral stones can be diagnosed by X-ray plain film. CT was superior to conventional X-ray and ultrasound in showing clearly the anatomy of genitourinary system and other abdomen. After the operation of ureteral calculi, the continuous nursing to the patients who were discharged with double J tube after the operation can effectively reduce the incidence of postoperative complications and improve their quality of life.

Vagal afferent responses to cystometry in rat models of urinary bladder irritation: c-fos immunohistochemistry study.

Although recent literature provides increasing evidence concerning urinary bladder innervation by vagal afferents, the functional aspects and the conditions at which these afferents are recruited are still unclear. In the present study, the neuronal responses of nodose ganglion following cystometry, under different models of rat's urinary bladder irritation, cyclophosphamide (CYP), cyclophosphamide with cervical vagotomy (Vx), chronic HCl, and acute HCl, were investigated using c-fos immunohistochemistry. The c-fos expression in the nodose ganglion, following cystometry, was increased significantly in the CYP and chronic-HCl groups compared to the intact, Vx, and acute-HCl groups. In addition, the acute-HCl group showed a significant increase compared to intact animals. Following cervical vagotomy, the expression in the Vx group decreased significantly compared to the CYP group, but was significantly higher than that in the intact group. The results of this study demonstrate the innervation of the vagus afferents to the urinary bladder. This innervation is activated under urinary bladder irritation conditions, which may indicate a possible role of the vagus nerve during urinary bladder pathology.

Ureteral Stent-Related Symptoms and Pharmacotherapy: A Brief Narrative Review.

The purpose of this article is to review the effects of different types of pharmacotherapy on symptoms that affect the quality of a patient's life after stent insertion. A thorough Medline/PubMed nonsystematic review was conducted from 1987 to January 2023, using the terms: "pigtail" OR "ureteral stents" AND "lower urinary tracts symptoms" OR "LUTS" AND "pharmacotherapy" OR "drugs". Relevant studies conducted in humans and reported in English language were included. The available reviews and articles associating the use of drugs with stent-related symptoms (SRS) provide conflicting results. Most of them show a clear benefit of alpha blockers, particularly alfuzosin, on treating urinary SRS, and hence there is a strong recommendation for the use of alpha blockers for the treatment of SRS in the guidelines of the European Association of Urology. Anticholinergics and mirabegron have shown a significant benefit in dealing with irritative bladder symptoms. In contrast, the findings for combination therapies are contradictory, with some studies showing that combination therapy is no superior to monotherapy with regards to most of the subsets of the Ureteral Stent Symptom Questionnaire (USSQ), whereas others present a clear benefit of combination therapies, specifically silodosin and solifenacin, in treating stent-associated lower urinary tract symptoms (LUTS), in comparison with any other type of monotherapy or combination therapy. Many studies suggest that some categories of pharmacotherapy, such as alpha blockers, can alleviate SRS. However, there is conflicting evidence concerning most other types of medical treatment. Randomized trials with the largest number of patients are needed to investigate the effectiveness of novel approaches on SRS.

Bladder Metastatic Breast Cancer Presenting Initially with Lower Urinary Tract Symptoms: A Rare Case Report

Introduction: Breast cancer (BC) is the most frequently diagnosed malignancy (25% of all cancers) and the leading cause of cancer-related death in women; death is mainly attributed to the metastatic spread of the primary tumor. On the other hand, secondary tumors of the bladder are rare, representing 2% of all bladder neoplasms. Breast cancer rarely spreads to the urinary bladder. Patients in almost all previous reports have been diagnosed with BC several months before the bladder metastasis (BM) was discovered. Case Presentation: A 67-year-old woman presented with irritative bladder symptoms with no history suggestive of BC. Normal breast examination and normal laboratory investigations with Breast Imaging Reporting and Data System 1 (BI-RADS 1) in mammographic evaluation challenged the pathological findings of the bladder biopsy that was positive for metastatized BC to the bladder. Conclusions: Metastatic BC may rarely initially present with irritative lower urinary symptoms and absent clinical and radiological features of BC-but positive histopathological findings.

Management of bladder spasms in patients with indwelling urinary catheters: A systematic review

Introduction:Bladder spasms caused by indwelling urinary catheters are a serious burden in patients in all settings. Medication may help, but comes with side effects. Little has been described on non-pharmacological interventions in day-to-day care. This systematic review aims to present an overview of interventions that nurses can apply to reduce bladder spasms in patients with indwelling urinary catheters, when removing the catheter is not an option. Material and methods:A systematic review was conducted, in accordance with PRISMA-guidelines. Terms focusing on urinary catheters and bladder spasms were searched for in EAUN Guidelines, Pallialine (NL), Cochrane, Cinahl, PubMed and Embase. A quality assessment was executed, using a critical review form, resulting in low, good or high quality reports. A best-evidence synthesis was carried out for similar interventions. Strong evidence means consistent findings in more than one high-quality report. Moderate evidence means consistent findings in one good-quality and at least one low-quality report. Insufficient evidence means one report found or inconsistent findings in more than one report. Results:After deduplication of 4.208 records, 2.658 unique records were screened for inclusion criteria, resulting in 20 included reports. The quality assessment identified 15 reports of low, 4 reports of good and 1 report of high quality. The best-evidence synthesis resulted in seven interventions with moderate evidence: reduce balloon size, fixation of catheter, use catheter valve, secure urine bag, treat constipation, increase fluid intake and a balanced, fiber-rich diet. Some interventions were only described in low-quality reports, resulting in low to moderate evidence: avoid bladder irritants, wait 24–48 h, resolve blockage of catheter and tubing, place urine bag lower than bladder. Other found interventions had insufficient evidence. Discussion:Most reports found were of low or good quality. However, many articles advocate for the same interventions, resulting in seven interventions of moderate evidence. Conclusions:Five interventions with low to moderate evidence need to be researched more thoroughly. In conclusion, the following interventions, easily applied by nurses, were found: reduce the balloon size, fixate the catheter, secure the urine bag or use a catheter valve, treat constipation, increase fluid intake and advice a balanced, fiber-rich diet.

Phase I/II randomized clinical trial of in-clinic acupuncture prior to BCG in patients with high-risk non-muscle invasive bladder cancer.

4590 Background: Acupuncture can reduce pain and urinary urgency and frequency. Treatment-related dose-limiting dysuria and irritative bladder symptoms are common in patients receiving intravesical Bacillus Calmette-Guerin (BCG) for the treatment of non muscle-invasive bladder cancer (NMIBC). We evaluated the feasibility, safety, and tolerability of weekly in-clinic pre-procedure acupuncture among patients receiving induction BCG. Methods: Patients with high-risk NMIBC undergoing induction BCG were randomized 2:1 to a standardized acupuncture protocol (Acu) or an attention waitlist control. Acu patients received acupuncture prior to each of 6 weekly BCG instillations. Feasibility was assessed via recruitment, retention, and intervention adherence. Acupuncture safety and tolerability were assessed via physician-reported CTCAE v5.0 and adverse events (AEs). Secondary endpoints included BCG treatment adherence, patient-reported BCG-related toxicity, and bladder cancer-specific and generic quality of life (QOL), assessed with the EORTC-QLQ-NMIBC-24 and -C30 surveys. Subjective assessments of acupuncture acceptability were assessed through patient exit surveys. Results: Between 1/21 and 7/22, 43 patients were randomized to Acu (n=28) vs. Control (n=15). Median age was 70.3 years and 76% were male. Week 7 follow-up surveys were completed by 93% of patients; 6 patients withdrew early due to disease progression, refractory gross hematuria, or for patient preference. Acupuncture was successfully delivered prior to each BCG treatment in Acu patients with no acupuncture-related AEs or interruptions to induction BCG. BCG-attributed AEs were reported by 91% Acu and 100% Control patients, including pain (28% vs. 43%, respectively, p=0.34) and urinary symptoms (62% vs. 79%, respectively, p=0.31). Comparing Acu with Controls, change in QOL over the study period demonstrated greater improvements in median urinary symptoms (9.5, IQR 0.0-19.0 vs. 0.0, IQR -14.3-7.1, p=0.02) and a trend towards improvement in median pain scores (16.7, IQR 0.0-16.7 vs. 8.3, IQR 0.0-33.3 p=0.68) among patients in the Acu arm. 96% of Acu patients reported that acupuncture was “very/extremely helpful” and 91% would recommend acupuncture to other patients. Conclusions: Acupuncture prior to induction BCG treatments is feasible and safe. In this Phase I/II trial, we observed reductions in pain and a trend towards improved urinary function scores over successive treatments among patients undergoing in-clinic pre-BCG instillation acupuncture. Patients receiving acupuncture reported high degrees of satisfaction with treatments. Future larger randomized controlled trials are needed to further characterize the efficacy of acupuncture with respect to pain, urinary symptoms and impact on QOL, and continuation of maintenance therapy during BCG treatment. Clinical trial information: NCT04496219 .

Open Label, Pilot Evaluation of the Safety and Efficacy of Intravesical Sustained Release System of Lidocaine and Oxybutynin (TRG-100) for Patients With Interstitial Cystitis/Bladder Pain Syndrome, Overactive Bladder and Patients With Retained Ureteral Stents Following Endourological Interventions

Intravesical instillation of analgesic and anticholinergic drugs have shown efficacy in the treatment of pain and voiding symptoms. Unfortunately, drug loss with urination and dilution in the bladder limit their durability and clinical usefulness. We have recently developed and tested in vitro, a sustained delivery system (TRG-100) of fixed-dose combination of lidocaine and oxybutynin designed to allow for a longer exposure of the urinary bladder to the drugs. To asses the safety and efficacy of TRG-100 in Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS), overactive bladder (OAB), and endourological intervention stented (EUI) patients in an open-label, prospective study. Thirty-six patients were enrolled: 10 IC/BPS, 10 OAB, and 16 EUI. EUI patients received a once-weekly installation until stent removal, OAB and IC/BPS patient received weekly installations for 4 consecutive weeks. Treatment effect was assessed by visual analog scale (VAS) score for the EUI group, voiding diaries for OAB group and VAS score, voiding diaries and O'Leary Sant Questionnaires for the IC/BPS group. The EUI group showed a mean 4-point improvement in their VAS score. The OAB group showed 33.54% reduction in frequency of urination and IC/PBS group showed a mean of 3.2-point improvement in their VAS score, 25.43% reduction in frequency of urination, and a mean 8.1-point reduction in O'Leary Sant Questionnaires score. All changes were statistically significant. Intravesical instillation of TRG-100 was found to be safe and efficient in reducing pain and irritative bladder symptoms in our study population. TRG-100 efficacy and safety should be further assessed in a large, randomized control trial.

(040) A Case Report of Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia Secondary to Lumbar Facet Cyst-Induced Sacral Radiculopathy Treated by Lumbar Endoscopic Spine Surgery

Abstract Introduction Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD), characterized by distressing, abnormal genito-pelvic sensations, especially unwanted genital arousal, may be triggered by pathology in Region 3, the cauda equina. Sacral radiculopathy is an inflammatory irritation of the S2-S3 nerve roots in the cauda equina, formed by convergence of pelvic, pudendal, and sciatic nerves and clinical symptoms that involve the sensory fields of these nerves. In a subgroup of patients, both cauda equina Tarlov cyst-induced sacral radiculopathy and lumbosacral annular tear-induced sacral radiculopathy have been reported to trigger PGAD/GPD, and in both conditions, endoscopic spine surgery has been shown safe and effective. Lumbar facet cysts, most common at the L4-L5 level, arise from lumbar zygapophyseal joints and can cause sacral radiculopathy. Thus, it is possible that lumbar facet cyst-induced sacral radiculopathy may be a trigger for PGAD/GPD. Objective To report one case of PGAD/GPD secondary to lumbar facet cyst-induced sacral radiculopathy, successfully treated with lumbar endoscopic spine surgery (LESS). Methods A 55-year old woman with a long history of PGAD/GPD presented to our spine-sexual medicine program for biopsychosocial assessment and treatment using our multidisciplinary management algorithm: Step A) detailed psychosocial and medical history; Step B) non-invasive assessments for sacral radiculopathy; Step C) targeted diagnostic transforaminal epidural spinal injection (TFESI) resulting in temporary clinically significant reduction of PGAD/GPD symptoms; Step D) surgical intervention with LESS and post-operative multidisciplinary follow-up. The patient was diagnosed with PGAD/GPD from lumbar facet cyst-induced sacral radiculopathy and underwent LESS for an L4-5 facet cyst. Results This 55 year old cisgendered woman had multiple painful spontaneous orgasms, shooting sharp pains that felt “like a bruise” going up the inside of her vagina, hypersensitivity of her vulva, clitoris, vagina, urethra and anus, along with constant symptoms of arousal and urinary urgency. These began in 2008 after her second childbirth. Her PGAD symptoms worsened over the last 2 years. She experienced sensations of pins and needles in her right buttocks, front of her left thigh, and down both legs into feet and toes. She also had severe constipation and restless leg syndrome. Neurogenital testing, including quantitative sensory testing, sacral dermatome testing and bulbocavernosus reflex latency testing, were all abnormal consistent with sacral radiculopathy. Region 1 anesthesia testing for vestibular pain showed persistent PGAD/GPD symptoms despite numbness on vestibular cotton swab testing. Pudendal nerve testing was negative. It was thus hypothesized that her PGAD/GPD trigger was closer to the central nervous system. Her MRI showed an L4-5 facet cyst. A TFESI with anesthetic was positive with temporary symptom reduction. She underwent LESS to excise the facet cyst and was discharged the same day. At early post-operative follow-up, she is PGAD-free. She no longer has irritative bladder symptoms, sciatica, restless leg syndrome, or pins and needles, and her constipation symptoms have improved. Conclusions Of the many recognized triggers for PGAD/GPD, we report for the first time a patient diagnosed with lumbar facet cyst-induced sacral radiculopathy after a multidisciplinary step-care management algorithm evaluation. She experienced marked improvement with lumbar endoscopic spine surgery. Disclosure No

(106) Hormonally-Mediated Vestibulodynia: A Chart Review

Abstract Introduction The borders of the vestibule are Hart’s line laterally, hymen medially, frenulum of the clitoris anteriorly, and fourchette posteriorly. Provoked vestibulodynia (PVD) is characterized by severe burning pain in response to pressure localized to the vestibule. Numerous factors may negatively affect the vestibule causing PVD such as hormonal changes, infections, trauma, exaggerated immunologic or inflammatory responses, dermatologic conditions, high-tone pelvic floor dysfunction, pudendal neuropathy, and sacral radiculopathy. PVD specifically associated with hormonal changes in pre-menopausal women has been termed hormonally mediated vestibulodynia (HMV). Dense labeling of androgen receptors has been noted in the germinal layer of the vestibular epithelium and mucinous minor vestibular glands, implying a critical role of testosterone in vestibular health. Low calculated free testosterone caused by elevated sex hormone binding globulin (SHBG) in pre-menopausal women using combined hormonal contraception may thus be harmful to the vestibular epithelium and minor vestibular glands, resulting in HMV. In HMV, vulvoscopy shows diffuse vestibular tenderness of the entire vestibule, the ostia of the minor vestibular glands are frequently erythematous (Fig 1) and blood testing is consistent with a low calculated free testosterone. Objective We describe the variation in etiologies for HMV and emphasize the importance of measuring total testosterone and SHBG to monitor calculated free testosterone levels in patients with HMV. Methods This is a retrospective chart review of premenopausal patients presenting to a clinic with entrance dyspareunia who were diagnosed with HMV, and whose symptoms were alleviated by treatment. Inclusion criteria were as follows: premenopausal females with initial testosterone and SHBG blood values below the reference range, initial vulvoscopy findings significant for vestibulodynia, follow-up testosterone and SHBG approaching the reference range, and follow-up vulvoscopies demonstrating a relief from symptoms. Results A total of 9 patients met the inclusion criteria. The mean age was 32 years old, with a range of 22 years old to 39 years old. Presenting complaints in addition to dyspareunia (n=9) included recurrent irritative bladder voiding symptoms without positive urine culture (n=3) and pelvic pain (n=4). Vulvoscopic examination including cotton-tipped swab testing of the vestibule revealed signs of vestibular hypersensitivity with pain ranging from 1 to 9 in all 7 regions of the vestibule tested. Patients had histories of having taken combined hormonal contraceptives (n=6), isotretinoin (n=1), spironolactone (n=1) and/or hormonal treatment for breast cancer (n=1), all of which can decrease calculated free testosterone. All patients were treated with systemic testosterone and compounded estradiol/testosterone cream to be applied daily to the vestibule. On follow-up blood testing, all patients had calculated free testosterone values approaching 0.6-0.8 ng/dl, established by Guay et al. as the optimum range. All patients reported significantly decreased dyspareunia and significant relief of other bothersome symptoms, especially bladder symptoms. Conclusions This chart review illustrates a variety of etiologies associated with low calculated free testosterone and the diagnosis of HMV. This data emphasizes the importance of calculating free testosterone and performing vulvoscopy to establish a diagnosis in pre-menopausal patients with entrance dyspareunia. Additionally, this chart review demonstrates the efficacy of systemic testosterone and local vestibular androgen/estradiol therapies in ameliorating vestibular pain and associated symptoms in patients with HMV. Disclosure No

Food Insecurity Is Associated With Urge Urinary Incontinence: An Analysis of the 2005-2010 National Health and Nutrition Examination Survey.

Urge urinary incontinence is the involuntary leakage of urine associated with a sudden compelling urge to void. A previous study found an association between urge urinary incontinence and household income, indicating that social determinants of health may influence urge urinary incontinence. Food insecurity is a relevant social determinant of health, as a diet with bladder irritants may worsen urge urinary incontinence symptoms. This study aimed to investigate the association between urge urinary incontinence and food insecurity. We collected data from the 2005-2010 cycles of the National Health and Nutrition Examination Survey, a nationally representative health survey administered by the Centers for Disease Control and Prevention. The association between urge urinary incontinence and food insecurity was analyzed using survey-weighed logistic regression with adjustments for demographic, socioeconomic status, behavioral, and medical comorbidities covariates. We included 14,847 participants with mean age 50.4±17.9 years; 22.4% of participants reported at least 1 episode of urge urinary incontinence. We found that participants who reported food insecurity had 55% greater odds of experiencing urge urinary incontinence compared to those who have not (OR=1.55, 95% CI=1.33-1.82, P < .001). When comparing diets, food-insecure participants reported significantly less intake of bladder irritants (caffeine and alcohol) compared to food-secure participants. When the sample was stratified by food insecurity status (yes vs no), consumption of caffeine did not differ by urge urinary incontinence status and consumption of alcohol was lower among participants with vs without urge urinary incontinence. Adults reporting food insecurity in the past year are significantly more likely to experience urge urinary incontinence than those who did not. Consumption of bladder irritants including caffeine and alcohol was significantly less in food-insecure compared to food-secure participants. When the sample was stratified by food insecurity status (yes vs no), consumption of caffeine did not differ by urge urinary incontinence status and consumption of alcohol was lower among participants with vs without urge urinary incontinence. These data indicate that diet alone does not drive the association between urge urinary incontinence and food insecurity. Instead, food insecurity may be a proxy for social inequity, perhaps the greatest driver of disease.

The application of gemcitabine and pirarubicin in patients with non-muscle invasive bladder cancer.

To investigate the value of gemcitabine and pirarubicin in patients with non-muscle-invasive bladder cancer (NMIBC). 405 patients with non-muscle invasive bladder cancer admitted to our hospital from January 2012 to December 2020 who underwent transurethral bladder tumor electronic resection were studied. 177 patients were treated with gemcitabine (Gemcitabine group) and 228 patients were treated with pirarubicin (Pirarubicin group) after surgery. The efficacy and adverse effects of the two groups were observed and the patients were followed up. No differences were found when comparing age, gender, smoking, bladder mass, number of masses, hypertension, diabetes, coronary artery disease, hematuria and tumor diameter between the 2 groups (P > 0.05). In the Gemcitabine group, bladder irritation signs, meatus hematuria, fever, nausea and vomiting were lower than those in the Pirarubicin group (P < 0.05). The recurrence rates were 6.21% and 12.28% at 1year, 11.86% and 23.68% at 2years, 15.82% and 25.88% at 3years in the Gemcitabine and Pirarubicin groups respectively, with the Gemcitabine group having a significantly lower recurrence rate than the Pirarubicin group (P < 0.05). The tumor recurrence-free survival rate for 5years of gemcitabine was significantly higher than that of the Pirarubicin group (P < 0.05). Gemcitabine and pirarubicin are both effective in treating patients with non-muscle invasive bladder cancer, with gemcitabine having a lower incidence of adverse reactions, a higher safety rating, a lower recurrence rate and an improved survival outcome.

Interstitial cystitis caused by immune dysregulation in LRBA deficiency: one among the rare urological manifestations in inborn errors of immunity

Inborn errors of immunity (IEI) rarely present with associated urological manifestations. Chronic cystitis and urethritis caused by ureaplasma and mycoplasma infection in hypogammaglobulinemia may result in bladder fibrosis. Papovaviridae such as BK or JC, can cause hemorrhagic cystitis in patients with T cell defects. Bladder granulomtata and urethral strictures can occur in chronic granulomatous disease. This is the first reported case of severe lymphocytic interstitial cystitis in a patient with lipopolysaccharide-responsive beige-like anchor protein (LRBA) deficiency. LRBA deficiency is known to impair CTLA-4 recycling, leading to decreased Treg cell function. A 13 year old male refugee presented with chronic recurrent debilitating suprapubic pain and dysuria, which progressed to extreme urinary frequency. He had a prior history of recurrent aseptic urinary tract infections, and one episode of gross hematuria. Extensive infectious investigations of urine (bacterial, mycobacterial cultures; viral PCRs), blood, and stool (Schistosoma) failed to isolate a pathogen. Bladder biopsy was positive for EBV by PCR but blood remained EBV-negative. Urinalysis showed microscopic hematuria while urodynamic studies were normal, and cystoscopy showed bladder and urethral irritation. Pathology confirmed lymphocytic interstitial cystitis, with primarily T cell infiltration. Immunological investigations revealed low IgG, IgA and IgM levels, B lymphopenia (1%), with low class-switched memory B cell development (3%) and absent response to protein and polysaccharide vaccine antigens. There were no signs of autoimmunity. Parents are consanguineous, and a sibling was likewise diagnosed with LRBA deficiency. Sanger sequencing of DNA confirmed the same homozygous family mutation in the LRBA gene, a likely pathogenic splice donor variant, c.2258+2T>G. The patient was started on immunoglobulin replacement. Trials of analgesics including NSAIDs, gabapentin, and morphine, and immunosuppression with corticosteroids and sirolimus, were unsuccessful in reducing urinary symptoms. Physiotherapy and antispasmodics were introduced when pelvic-floor dyssynergia with rectal pain developed. Subsequently-presenting enteropathy was managed with Abatacept (CTLA-4 IgG1 fusion protein), ultimately improving bladder symptoms after several months of therapy. Patient has since undergone HSCT and is now free of urinary tract symptoms. LRBA deficiency presents with hypogammaglobulinemia, infections, and immune dysregulation presenting with lymphocytic infiltration of non-lymphoid organs. This report highlights the phenotypic diversity of this disease.