Cases Of Interstitial Cystitis Research Articles

Analysis of viruses present in urine from patients with interstitial cystitis.

The question of whether some cases of interstitial cystitis may have an infectious etiology has been debated for some time. Previous studies have looked for the presence of certain specific viruses, but generally did not use the types of sensitive and unbiased approaches that are currently available. As part of the MAPP (Multidisciplinary Approach to the Study of Chronic Pelvic Pain) Research Network, we examined urine specimens from interstitial cystitis patients who provided specimens over time and also reported various symptoms at the time of urine collection. We first performed next-generation sequencing to look for the presence of viruses in urines, and detected two human polyomaviruses that are known to be excreted into urine, BKPyV and JCPyV. We were especially interested in BKPyV because it is a known cause of another bladder disease, hemorrhagic cystitis, in bone marrow transplant recipients. Further analysis of individual samples indicates a trend toward higher excretion of polyomaviruses in patients experiencing increased symptoms.

間質性膀胱炎のアレルギー学的研究 : (1)イカとエビアレルギーによる間質性膀胱炎の1例

間質性膀胱炎のアレルギー学的研究 : (1)イカとエビアレルギーによる間質性膀胱炎の1例

間質性膀胱炎のアレルギー学的研究 (2) : 扁桃性病巣感染によると考えられる膀胱壁の好酸球増加を伴った間質性膀胱炎の1例

間質性膀胱炎のアレルギー学的研究 (2) : 扁桃性病巣感染によると考えられる膀胱壁の好酸球増加を伴った間質性膀胱炎の1例

Evaluation and Management of Failed Bladder Augment

Augmentation cystoplasty has been studied and performed by urologists for over 100 years. Although specific indications, techniques, and materials used have undergone major change and revisions during this period, the general concepts have remained unchanged. Bladder augmentation is used to “augment” the bladder’s ability to store. Specific indications include structurally diminished bladder capacity, neurogenically incapacitated bladder, special circumstances of overactive bladder and terminal cases of interstitial cystitis. As augmentation is mostly performed to improve capacity and to eliminate urinary incontinence, most failures relate to the inability to achieve this. Failure to achieve continence, improve bladder capacity or reduce bladder pressures with subsequent upper tract deterioration are results of failed augmentation cystoplasty. Underlying causes of these failures are described in this manuscript.

IJU this issue

This issue contains two Editorials, one Review article, three Original articles, one Case Report, three Short Communications, and two Letters to the Editor. This issue starts with an Editorial by Professor Razack (Kuala Lumpur, Malaysia). Professor Razack, of the University of Malaya, describes the history and current status of urology in Malaysia. The Malaysian Urological Association (MUA) was founded in 1974, and aims to strengthen closer links within Asia and rest of the world's urological communities. Urology in Malaysia had made great strides since its humble start in the late 1960s to its current status, in which most of the latest equipment and facilities are available within the country. There are three da Vinci robots in the country and many laser machines for both treatment of stones and prostate diseases. MUA continues to look for opportunities to host international conferences and meetings. The review by Kitajima et al. (Kobe, Japan) describes recent issues in contrast-induced nephropathy (CIN). CIN is a serious complication among patients undergoing contrast-enhanced computed tomography with potentially high morbidity and mortality. Patients with pre-existing renal insufficiency appear to be at higher risk of CIN. To prevent CIN, every effort is required, including the routine identification of at-risk patients, the use of appropriate hydration regimens, the withdrawal of nephrotoxic drugs, the selection of a low-osmolality or iso-osmolar contrast medium (CM), and using the minimum volume of CM possible Cao et al. (Qingdao, China) determine whether steroidogenic enzyme expression is associated with the steroid secretory pattern of subclinical Cushing's syndrome (SCS) by investigating the mRNA and protein expression of CYP17 and CYP11B1 in SCS adenomas. They found that CYP11B1 and CYP17 are overexpressed in subclinical cortisol-producing adenomas (CPA) and their overexpression accounts for the increased production of cortisol that is characteristic of CPA. Gacci et al. (Florence, Italy) report factors predicting the recovery of continence after a radical prostatectomy (RP). They found that preoperative erectile function can predict post-prostatectomy incontinence, and bladder neck preservation has a significant effect on early continence recovery after RP. Kobayashi et al. (Sapporo, Japan) report an animal model for erectile dysfunction (ED) following lower urinary tract symptoms (LUTS) and bladder outlet obstruction (BOO). Male Sprague–Dawley rats with partial BOO are an experimental model of LUTS and ED. The partial-BOO rats show decreased erectile function due to endothelial dysfunction induced by impaired eNOS function. Sugimoto et al. (Saga, Japan) report a rare case of a ureterosciatic hernia successfully treated by a ureteral placement. Non-enhanced computed tomography reveals left hydroureteronephrosis and obstruction of the distal left ureter with herniation into the sciatic foramen. After 2 months with treatment with the stent, there was no recurrence. The three Short Communications are of great interest. Suzuki et al. (Tokyo, Japan) analyze the results of direct decompressive surgery plus stabilization of the vertebrae involved in six non-ambulatory patients with metastatic extradural spinal cord compression due to renal cell carcinoma. Tanaka et al. (Tokyo, Japan) evaluate diffusion-weighted magnetic resonance imaging in differentiating between minimal fat angiomyolipoma and clear cell renal cell carcinoma. Kozyrakis et al. (Athens, Greece) report on their experience with six patients diagnosed with lymphoepithelioma-like bladder carcinoma over the past 15 years. The Letter to the Editor from Nomiya et al. (Tokyo, Japan) report the first Japanese case of interstitial cystitis (IC) symptoms associated with ketamine abuse. Ketamine abuse should be included in the differential diagnoses for those presenting with LUTS suggestive of IC. The Letter to the Editor from Adam (Pretoria, South Africa) describes a message about an article by Ochiai et al. (International Journal of Urology 2011; 18: 200–5). He points out importance of combination threshold values for the PCA3 assay and prostate-specific antigen (PSA) levels, or a normal digital rectal examination (DRE), or both, to identify the presence of cancer. In their cohort study, a PCA3 score <60 associated with a PSA level <4 ng/mL and a normal DRE excluded the presence of cancer on histology. None declared.

Decreased Viral Load and Symptoms of Polyomavirus‐Associated Chronic Interstitial Cystitis after Intravesical Cidofovir Treatment

Interstitial cystitis causes disabling bladder pain and is usually diagnosed in the absence of infection. We describe a patient with interstitial cystitis who had high urinary levels of polyomavirus that decreased dramatically after initiation of intravesical cidofovir treatment; the patient also showed substantial improvement in symptoms. Another patient had milder symptoms of cystitis and intermittent polyomavirus shedding. Polyomaviruses, particularly BK virus, may cause some cases of interstitial cystitis.

Sequential hydrodistension and intravesical instillation of hyaluronic acid under general anaesthesia for treatment of refractory interstitial cystitis: a pilot study

Pilot study looking at the combination of general anaesthetic hydrodistension and intravesical hyaluronic acid for treatment of refractory interstitial cystitis. Twenty-three treatment refractory patients were recruited with an average age 53.4 years. All underwent general anaesthetic cystoscopy, hydrodistension and instillation of hyaluronic acid (40 mg/50 ml). The bladder was then subsequently drained with the patient awake. Two initial treatments were carried out a month apart and duration between treatments increased depending upon symptom response. In the responders, the average number of treatments was 6.6 (median 4.5), duration between treatments was 3.1 months (median 2.6) and follow-up 15.8 months (median 16). Seventeen patients (74%) responded with immediate improvement in symptoms. In all responders, healing of ulceration and resolution of inflammation occurred. Average anaesthetic bladder capacity increased in the responder group from an average of 492 ml (median 500 ml) to an average of 776 ml (median 700 ml). Our pilot data suggests sequential hydrodistension and hyaluronic acid treatment under general anaesthesia may be considered for resistant cases of interstitial cystitis, especially those that cannot tolerate the instillation procedure under local anaesthesia. Further prospective trials are required.

Hyperbaric oxygen therapy for interstitial cystitis resistant to conventional treatments

We treated two cases of interstitial cystitis (IC) that were resistant to some conventional therapies with hyperbaric oxygen (HBO). Both patients underwent 20 sessions of 100% oxygen inhalation (2.0 atmosphere absolute for 60 min/day x 5 days/week for 4 weeks) in a hyperbaric chamber. The period of follow up was 12 months for case 1 and 9 months for case 2. After a course of HBO, the bladder mucosal ulcer (Hunner's ulcer) disappeared, and changes from baseline in pain and urinary frequency was constitutively inhibited. There were no adverse events during the 20 treatment sessions. One woman (case 1) had mild Eustachian tube dysfunction, resulting in a transient hearing impairment. HBO seems to be an option for treatment of IC resistant to conventional therapies.

Refractory case of Interstitial Cystitis associated with Sjogren's syndrome: Beneficial effect of Steroids in Treatment

Interstitial Cystitis (IC) is of unknown aetiology, but recently has been associated with Sjogren's syndrome. This association is much stronger than was originally recognised. In these patients the question has always been whether the bladder symptoms were a manifestation of IC or an autoimmune process. The beneficial response seen in some patients to steroids tends to support the latter. We report a case of severe IC associated with Sjogren's syndrome in whom bladder symptoms responded to a course of steroids where other conventional management did not help. We believe that a high index of suspicion for the association of these two diseases would help treat some of the refractory cases of IC with a trial of corticosteroids.

Is interstitial cystitis an allergic disorder?: A case of interstitial cystitis treated successfully with anti‐IgE

Interstitial cystitis (IC) is a chronic disorder diagnosed by symptomatology of pelvic pain and urinary frequency, which are extremely variable and unpredictable fluctuating among patients. IC has recently been found combined with some allergic disorders and histopathologic abnormalities resembling that of allergic disorders, including mast cell activation, histamine release and eosinophil infiltration. Therefore, it could be cautiously postulated that IC is one of the allergic disorders of the urogenital system. A 28-year-old Caucasian female patient, who was diagnosed with asthma and allergic rhinitis, suffered from bladder symptoms of frequency, urgency and pelvic pain for the past 3 years. The symptoms disturbed her every day and were intractable for treatment. Urologists concluded that she had interstitial cystitis. Specific immunotherapy (SIT) was recommended for her allergic symptoms. While taking specific immunotherapy, she had anaphylaxis. She still had the reaction even with the 1000-fold diluted shot of SIT. Omalizumab was used for her allergic symptoms and possible prevention of anaphylactic reaction to SIT. Interestingly, she reported that her urogenital symptoms had subsided since omalizumab had been started. According to the published literature, we postulate that interstitial cystitis might be one of the IgE mediated, mast cell driven allergic disorders of the urogenital system. Therefore, in this case, the patient's bladder symptoms are successfully controlled primarily by anti-IgE therapy and the improvement could be maintained by SIT. We report, for the first time, a case of interstitial cystitis with allergic rhinitis and asthma, successfully treated by anti-IgE therapy and specific immunotherapy.

Advances in the treatment of interstitial cystitis

Recent years have brought dramatic advances in the clinician’s ability to offer effective pharmacotherapy to patients who have interstitial cystitis. Medical treatments have been developed and applied to reduce the interstitial cystitis symptoms of pelvic pain and urinary urgency/frequency, and to address underlying causes of the disorder. In addition, advances in the understanding of the natural history of interstitial cystitis have revealed that it is insidiously progressive and the classical definition – rare, severe and difficult to treat – is in fact the relatively uncommon, advanced stage of a disorder that affects most individuals in a mild-to-moderate and readily treatable form. This recognition has led to the identification of large numbers of previously unsuspected cases of interstitial cystitis, and the successful treatment of many individuals in the early stages of interstitial cystitis when it is far more responsive to therapy. A heparinoid-based multimodal medical regimen can effectively control symptoms and address disease pathophysiology in the majority of cases. Intravesical therapeutic solutions are new and promising adjunctive therapies that can offer immediate symptom relief during symptom flares, and for patients who are just beginning medical therapy.

Interstitial Cystitis and Infectious Agents

Interstitial cystitis (IC) is a syndrome consisting of severe refractory bladder symptoms of unknown etiology. The disease tends to affect Caucasian women with a mean age of 40 years, with 25% of patients under the age of 30. Few population based epidemiological studies of IC have been performed. We analyzed a case of interstitial cystitis in a 42-year-old non-smoker woman. In two biopsy samples the presence of viral DNA of human polyomavirus BK (BKV), human herpes virus type 1 and type 2 (HHV- 1 and HHV-2), adenovirus, human papillomavirus (HPV) and bacterial DNA (Chlamydia trachomatis and Mycoplasma genitalium) were evaluated by means of polymerase chain reaction (PCR). Both samples resulted positive only for BKV and HPV DNA. HPV genotyping revealed the presence of HPV-66 that is associated with a high risk of cancer development. Thus the finding of a viral co-infection could support the hypothesis of the multi-factorial origin of this pathology.

A case of interstitial cystitis accompanying Sj�gren?s syndrome

A 51-year-old woman with interstitial cystitis was referred for screening of autoimmune disease. She was positive for results of Schirmer and Saxon tests and for ss/A and ss/B antibodies. Autoantibodies to type 3 muscarinic acetylcholine receptor were detected in the patient's serum by Western blotting. We diagnosed her as having interstitial cystitis accompanying Sjögren's syndrome. To enable early treatment, interstitial cystitis should be considered when patients with Sjögren's syndrome complain of urinary symptoms.

The Effect of Lumbar Sympathetic Block in Interstitial Cystitis -A case report-

Interstitial cystitis is an extremely painful and distressing condition, characterized by severe suprapubic pain, which increases with bladder filling and is relieved by voiding. The daily frequency of micturition may approach 100 times, but no incontinence is observed. The symptoms persist throughout the night, which consequently affects sleep. The etiology of this condition is still unknown, but includes infection, autoimmune response, allergic reaction, neurogenic inflammation, epithelial dysfunction and inherited susceptibility. Herein, a case of interstitial cystitis, with severe symptoms, which was successfully treated with lumbar sympathetic block, is reported.

Supratrigonal cystectomy and ileocystoplasty in management of interstitial cystitis.

Interstitial cystitis is a chronic non-infectious inflammatory disease of the bladder of unknown aetiology which is characterized by irritative voiding symptoms and suprapubic pain related to bladder filling. Surgical treatment is indicated in severely symptomatic patients when medical therapies have failed, usually after a period of several years. The authors' experience with a modified technique of ileocystoplasty following supratrigonal cystectomy performed in five patients with interstitial cystitis is presented here. A modified technique of bladder augmentation using ileum following supratrigonal bladder resection is described. All patients experienced relief from their symptoms. No patient had residual bladder pain and urinary frequency settled down in all. Bladder capacity was increased significantly. Three patients voided spontaneously postoperatively and two required clean intermittent self-catheterization. Supratrigonal cystectomy and ileocystoplasty can be a satisfactory option in refractory cases of interstitial cystitis. A simplified technique of ileal bladder construction that provides satisfactory bladder capacity is presented. Most urologists are familiar with ileal surgery, having used the ileum as a conduit after cystectomy for urinary diversion.

EPIDEMIOLOGY OF INTERSTITIAL CYSTITIS: A POPULATION BASED STUDY

Interstitial cystitis is a chronic and debilitating syndrome but surprisingly little is known about its epidemiology. This study was designed to estimate the prevalence of interstitial cystitis among women in the United States. Female participants in the Nurses' Health Study (NHS) I and II (184,583) were asked by mailed questionnaires whether they had ever been diagnosed with interstitial cystitis. We requested and reviewed medical records of women self-reporting interstitial cystitis. The accuracy of self-reports was evaluated using standardized criteria. Among the 93,428 women who responded to the NHS II questionnaire and 91,155 women who responded to the NHS I questionnaire 1,354 (1.4%) and 357 (0.4%), respectively, self-reported interstitial cystitis. Based on medical record review 63 cases of interstitial cystitis were confirmed in NHS II and 47 in NHS I. The prevalence of interstitial cystitis was 67/100,000 women in NHS II and 52/100,000 in NHS I. There was no substantial variation in prevalence by age. The prevalence of interstitial cystitis in the United States is more than 50% greater than previously reported and 3-fold greater than that reported in Europe.

Orthotopic bladder substitution in women

Orthotopic bladder substitution in women is a well accepted procedure for most benign cases. Recent investigations in this field have produced long-term results in interstitial cystitis, which has been a much disputed indication for any type of surgical intervention. However, under the precondition of appropriate patient selection, orthotopic bladder substitution turns out to be an effective therapeutic tool for conservative refractory cases of interstitial cystitis. One of the major recent developments in urological oncological surgery is the utilization of orthotopic bladder substitution in females for lower urinary tract reconstruction in combination with invasive bladder cancer. Functional as well as oncological aspects have been the basis for a decade-long uneasiness to follow the first successful trials. During the past 2 years reports have been published about approximately 100 patients who underwent such an operation. The early results make it seem reasonable to continue these trials, but a critical judgement is at least 3 years in the future.

Associations among cystoscopic and urodynamic findings for women enrolled in the interstitial cystitis data base (ICDB) study

Objectives Interstitial cystitis is a symptom complex characterized by pelvic pain, urinary urgency, urinary frequency, and nocturia. Patients with these symptoms, at the 5 clinical centers participating in the National Interstitial Cystitis Data Base (ICDB) Study, have been evaluated with history and physical exams, questionnaires, and urodynamic studies. Methods Of the 388 female subjects entered in the study as of December 31, 1995, 150 women have undergone cystoscopy with hydrodistension. The data from the endoscopic procedures and the urodynamic studies were analyzed. The associations among cystoscopic and urodynamic findings were reviewed. Results Patient demographics of this subgroup show a predominance of Caucasians 139/150 (92.7%), with the average age being 43 (± 13.2) years. Of the total, 17 patients (11.3%) had a Hunner's patch (HP). The prevalence by center varied from a low of 2/38 (5.3%) to a high of 3/9 (33.3%). Bloody effluent following hydrodistension was present in 113/150 (75.3%). Glomerulations appeared in varying degrees (mild, moderate, severe) in 91.3% of the 150 patients. There was a strong inverse relationship ( P < 0.001) between bladder capacity under anesthesia and the presence of a HP (mean of 845 cc with HP absent versus a mean of 531 cc when present). The incidence of HP varied from 67.6% among women with a bladder capacity at hydrodistension of <400 cc to 3.8% for those with a bladder capacity of at least 800 cc. The presence and increasing severity of glomerulations was positively associated ( P < 0.003) with the presence of HP, ranging from 0/13 (0%) when glomerulations were not present to 6/31 (19.4%) when glomerulations were graded as severe. Of the patients with HP, 17/17 (100%) had glomerulations after hydrodistension. HP is more closely associated with the moderate to severe range of glomerulations ( P < 0.01). Nearly half of the patients with HP or 8/17 (47.1 %) had “moderate” glomerulations, while 6/17 (35.3%) had “severe” glomerulations. The volume at first sensation to void on urodynamics (mean 87 cc without HP versus 34.7 cc with HP) was highly inversely associated ( P = 0.002) with the presence of HP, but not with any of the other cystoscopic findings. Of patients with HP, 94% had a volume at first sensation to void of ≤50 cc where only 36% of patients without HP had a volume at first sensation to void of ≤50 cc. The volume at maximum capacity on urodynamics was positively associated with the volume at hydrodistension ( P < 0.001). Conclusions Overall, patients with HP had lower bladder capacities, lower volumes at first sensation to void, and more severe glomerulations. Thus, the presence of HP would imply a more severe case of interstitial cystitis. Logically, a higher bladder capacity on cystometrogram is associated with a higher volume at the time of hydrodistension, and bloody effluent is associated with more severe glomerulations.

A case of interstitial cystitis and Hunner's ulcer in a domestic shorthaired cat

An 8-year-old spayed, domestic, shorthaired cat was examined with signs of feline urological syndrome which were unresponsive to previous therapy with antibiotics and urinary acidifiers. Biopsy of the bladder revealed signs of cystitis similar to interstitial cystitis in humans. Treatment with sodium pentosan polysulphate resulted in a decreased frequency of urination and resolution of haematuria. This condition may be more widespread in cats than realised, as it is only by bladder biopsy that diagnosis can be made.

Increased Mast Cells of the Bladder in Suspected Cases of Interstitial Cystitis: A Possible Disease Marker

Mast cells reportedly have been increased in the detrusor muscle bundles of the bladder in patients with interstitial cystitis. In 30 patients with suspected interstitial cystitis quantification of mast cells within the muscularis and submucosa was done. The results were compared to those obtained from a variety of normal bladder specimens removed surgically (16 specimens) and at autopsy (15), and from bladders with a variety of miscellaneous inflammatory conditions (20). In patients with suspected interstitial cystitis the number of mast cells was increased significantly (p less than 0.001) compared to the 3 control groups. This finding suggests that quantification of mast cells in the muscularis may be a useful marker in the histopathological evaluation of bladder biopsies in patients with suspected interstitial cystitis.