Chronic Cystitis Research Articles

99. Presence of Chronic Diseases and Compliance with Québec Provincial Guidelines for Outpatient Antibiotic Prescription, Québec, Canada, 2010-2017

BackgroundIn Québec primary care, antimicrobial use is higher in patients with chronic diseases, but it is unclear whether this utilization may be reduced. We aimed to measure the proportion of compliant antimicrobial prescriptions according to the provincial guidelines for the treatment of common respiratory and urinary infections and measure variations in this proportion with certain chronic diseases. MethodsAntimicrobial dispensing covered by the public drug insurance plan between April 2010 and March 2017, delivered within 2 days of an outpatient consultation for an infection was included. Infections targeted by provincial guidelines were studied: otitis media, pharyngitis, pneumonia, sinusitis, bronchitis and chronic obstructive pulmonary disease exacerbations, cystitis, and acute pyelonephritis. The proportion of prescriptions compliant with guidelines (right antimicrobial for children, and right antimicrobial and dosage for adults) was computed by age group (children or adults) and per category of chronic disease (respiratory, cardiovascular, diabetes, mental disorder, none of previous). For each infection and age group, multivariate robust Poisson regression was used to measure the impact of categories of chronic diseases on proportions of prescriptions compliant with guidelines. ResultsBetween 14 677 and 312 786 prescriptions were included, for each infection. Compliance to guidelines was above 87% in children and was significantly lower (≤ 3% bellow) in children with asthma. In adults, the choice of agent was compliant for at least 73% of prescriptions, except for cases of pharyngitis (between 53% and 61%). Accounting for dosage led to lower proportions of compliance, which varied between 19% (cystitis with diabetes) and 77% (pyelonephritis with none of the studied chronic disease categories). Compliant prescriptions were 2,4% to 20,4% less frequent in the presence of chronic diseases (statistically significant). ConclusionNon-compliant prescriptions could still be appropriate, but their high frequency suggests there is room for improvement. Dosage seems particularly problematic. Additional support could be offered to clinicians for the prescription of antimicrobials to patients with chronic diseases. Disclosures All Authors: No reported disclosures

Review article: Physical and psychological comorbidities associated with irritable bowel syndrome.

Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders encountered by physicians in primary and secondary care. Patients with IBS commonly present with various extraintestinal complaints, which account for a substantial clinical and economic burden. The common extraintestinal comorbidities associated with IBS include anxiety, depression, somatisation, fibromyalgia, chronic fatigue syndrome, chronic pelvic pain, interstitial cystitis, sexual dysfunction and sleep disturbance. The presence of comorbidity in IBS poses a diagnostic and therapeutic challenge with patients frequently undergoing unnecessary investigations and interventions, including surgery. This review discusses the different physical and psychological comorbidities associated with IBS, the shared pathophysiological mechanisms and potential management strategies.

Изучение структуры и микрофлоры тканей уретры при уретральном болевом синдроме

Urethral pain syndrome (UPS) is characterized by the occurrence of persistent or recurrent pain in the urethra in the absence of a confirmed infection and other obvious local pathological changes. The study of its pathogenetic aspects is important first of all for understanding the causes of the disease, to prescribe effective treatment, specific recommendations for the prevention and treatment of this disease are also absent. This paper presents the advanced experience of our research group on the study of the urethral state by the in vivo cross-polarization optical coherence tomography (CP OCT) method, and also the results of the microbiota analysis in the urethral tissues. The purpose of the study is to search for the risk factors for UPS and the character of changes in the urethral tissues, using the data of: 1) concomitant pathology, 2) structural changes in the urethral wall in UPS in comparison with chronic cystitis of bacterial etiology 3) studying the microbiota of urethral tissues. Materials and methods The condition of the urethra was studied in 109 patients: 55 of them with UPS (group US), without clinical manifestations of inflammation; 41 - with chronic inflammation of the lower urinary tract of various origins (group Inf); in 14 patients with stones of the upper urinary tract without pyelonephritis, the urethra was taken as the norm (group N). All performed a clinical minimum of studies, also cystoscopy with the study of the bladder triangle, the neck of the bladder and the urethra by the method of in vivo tissue imaging - CP OCT. The device OCT-1300U with wavelength of 1300 nm is used. To determine the possible role of UPS disease background, the analysis of concomitant pathology preceding the development of UPS was performed. To analyze the relationship of changes in the urethral tissues with the composition of its microbiota, a PCR study of biopsies from the proximal segment of the urethra was performed in 13 patients with UPS. Results Qualitative comparison of the thickness and character of the OCT signal of the urethral wall layers observed using CP OCT in the studied groups of patients allowed us to establish that the state of the epithelium and connective tissue structures of the mucous membrane in patients with UPS is not the norm, changes are similar to those in chronic inflammation. Changes in the character of the OCT signal were recorded in all parts of the urethra, but in the middle third they are most pronounced and most critical. In UPS, there is a brightly pronounced reorganization of the connective tissue stroma components. Pronounced fibrosis of subepithelial structures (increased signal brightness in the cross-channel compared to the norm) with their thickening was recorded in 48.2% of cases, and thinning/lack of visualization of the epithelial layer was detected in 20.5%, and in chronic inflammation 55.5% and 40.6% of cases, respectively. According to the results of PCR, only one patient had significant total bacterial contamination of the biopsy (TB=104.7). In all other cases, the total bacterial mass of the biopsies was at the level of negative control. Conclusions In patients with UPS, the presence of several concomitant, often chronic, diseases was revealed, which may be a premorbid background and one of the risk factors for the occurrence and maintenance of UPS. Pilot PCR studies of biopsies from the proximal segment of the urethra indicate that low values of bacterial contamination in the majority of patients with UPS do not exclude the possible role of bacteria in the development of the disease in some patients. The CP OCT method used in this study is currently the only one in vivo method of visualization of the urethral mucosa, which provides real-time images of structural changes in the epithelial (atrophy or hyperplasia) and connective tissue (active or latent inflammation with cellular infiltration or fibrosis) layers of the urethra, allowing better understanding of the pathogenesis of the disease and monitoring of therapy.

A multicenter study of antimicrobial prescriptions for cats diagnosed with bacterial urinary tract disease.

ObjectivesThe aim of this study was to evaluate initial antimicrobial therapy in cats diagnosed with upper or lower bacterial urinary tract infections at veterinary practices in the USA and Canada.MethodsElectronic medical records from a veterinary practice corporation with clinics in the USA and Canada were queried between 2 January 2016 and 3 December 2018. Feline patient visits with a diagnosis field entry of urinary tract infection, cystitis and pyelonephritis, as well as variation of those names and more colloquial diagnoses such as kidney and bladder infection, and where an antimicrobial was prescribed, were retrieved.ResultsPrescription data for 5724 visits were identified. Sporadic cystitis was the most common diagnosis (n = 5051 [88%]), with 491 (8.6%) cats diagnosed with pyelonephritis and 182 (3.2%) with chronic or recurrent cystitis. Cefovecin was the most commonly prescribed antimicrobial for all conditions, followed by amoxicillin–clavulanic acid. Significant differences in antimicrobial drug class prescribing were noted between practice types and countries, and over the 3-year study period. For sporadic cystitis, prescription of amoxicillin–clavulanic acid increased significantly and cefovecin decreased between 2016 and 2018, and 2017 and 2018, while fluoroquinolone use increased between 2017 and 2018.Conclusions and relevanceThe results indicate targets for intervention and some encouraging trends. Understanding how antimicrobials are used is a key component of antimicrobial stewardship and is required to establish benchmarks, identify areas for improvement, aid in the development of interventions and evaluate the impact of interventions or other changes.

Robotic-Assisted Laparoscopic Rectal Prolapse Repair in a Patient with Indiana Pouch.

Study Objective To highlight the surgical techniques for ventral rectopexy with sacrocolpopexy in the face of extensive abdomino-pelvic adhesions and to present the use of strattice reconstructive tissue matrix as a viable option in a patient with significant previous abdominal surgeries and decreased peritoneum available for mesh coverage. Design Surgical video presentation. Setting Academic tertiary care center. Patients or Participants We present a 26-yo nulliparous patient with recurrent rectal prolapse. She had failed a previous rectopexy repair 4 years prior. Her medical history is significant for Ehlers Danlos Syndrome, chronic pelvic pain and interstitial cystitis refractory to medical management. This prompted surgical interventions in the form of hysterectomy with bilateral salpingectomy, cystectomy and creation of an Indiana Pouch. Interventions Evaluation with a dynamic MRI proctogram showed pelvic floor laxity with a moderate anterior rectocele and large enterocele. At laparoscopy there was significant adhesions of omentum and bowel to the anterior abdominal wall, extending into the pelvis. Careful lysis of adhesions was started laparoscopically in order to create safe entry points for the robotic trocars and to delineate the anatomical landmarks for the rectopexy and sacrcolpopexy. Prolene mesh was secured to the exposed levator ani muscles, attached to the rectal wall and then extended to the sacral promontory. Strattice mesh was then fashioned and extended from the back of the pubic symphysis to the sacral promontory. Measurements and Main Results The patient was discharged on post op day 1 and at her postoperative review she was recovering well with no bowel dysfunction or rectal prolapse symptoms. Her Indiana Pouch remained functional. Conclusion The safety and feasibility of a robotic-assisted laparoscopic rectopexy was demonstrated in this surgical video even with extensive pelvic adhesive disease. Strattice matrix can safely be used to separate Prolene mesh from the intra-abdominal contents therefore, minimizing postoperative morbidity and increasing the chances of good functional outcomes. To highlight the surgical techniques for ventral rectopexy with sacrocolpopexy in the face of extensive abdomino-pelvic adhesions and to present the use of strattice reconstructive tissue matrix as a viable option in a patient with significant previous abdominal surgeries and decreased peritoneum available for mesh coverage. Surgical video presentation. Academic tertiary care center. We present a 26-yo nulliparous patient with recurrent rectal prolapse. She had failed a previous rectopexy repair 4 years prior. Her medical history is significant for Ehlers Danlos Syndrome, chronic pelvic pain and interstitial cystitis refractory to medical management. This prompted surgical interventions in the form of hysterectomy with bilateral salpingectomy, cystectomy and creation of an Indiana Pouch. Evaluation with a dynamic MRI proctogram showed pelvic floor laxity with a moderate anterior rectocele and large enterocele. At laparoscopy there was significant adhesions of omentum and bowel to the anterior abdominal wall, extending into the pelvis. Careful lysis of adhesions was started laparoscopically in order to create safe entry points for the robotic trocars and to delineate the anatomical landmarks for the rectopexy and sacrcolpopexy. Prolene mesh was secured to the exposed levator ani muscles, attached to the rectal wall and then extended to the sacral promontory. Strattice mesh was then fashioned and extended from the back of the pubic symphysis to the sacral promontory. The patient was discharged on post op day 1 and at her postoperative review she was recovering well with no bowel dysfunction or rectal prolapse symptoms. Her Indiana Pouch remained functional. The safety and feasibility of a robotic-assisted laparoscopic rectopexy was demonstrated in this surgical video even with extensive pelvic adhesive disease. Strattice matrix can safely be used to separate Prolene mesh from the intra-abdominal contents therefore, minimizing postoperative morbidity and increasing the chances of good functional outcomes.

The Role of PIEZO1 in Urinary Bladder Function and Dysfunction in a Rodent Model of Cyclophosphamide-Induced Cystitis.

In the urinary bladder, mechanosensitive ion channels (MSCs) underlie the transduction of bladder stretch into sensory signals that are relayed to the PNS and CNS. PIEZO1 is a recently identified MSC that is Ca2+ permeable and is widely expressed throughout the lower urinary tract. Recent research indicates that PIEZO1 is activated by mechanical stretch or by pharmacological agonism via Yoda1. Aberrant activation of PIEZO1 has been suggested to play a role in clinical bladder pathologies like partial bladder outlet obstruction and interstitial cystitis/bladder pain syndrome (IC/BPS). In the present study, we show that intravesical instillation of Yoda1 in female Wistar rats leads to increased voiding frequency for up to 16 hours after administration compared to vehicle treatment. In a cyclophosphamide (CYP) model of cystitis, we found that the gene expression of several candidate MSCs (Trpv1, Trpv4, Piezo1, and Piezo2) were all upregulated in the urothelium and detrusor following chronic CYP-induced cystitis, but not acute CYP-induced cystitis. Functionally with this model, we show that Ca2+ activity is increased in urothelial cells following PIEZO1 activation via Yoda1 in acute and intermediate CYP treatment, but not in naïve (no CYP) nor chronic CYP treatment. Lastly, we show that activation of PIEZO1 may contribute to pathological bladder dysfunction through the downregulation of several tight junction genes in the urothelium including claudin-1, claudin-8, and zona occludens-1. Together, these data suggest that PIEZO1 activation plays a role in dysfunctional voiding behavior and may be a future, clinical target for the treatment of pathologies like IC/BPS.

S1736 A Case of Primary Signet Ring Cell Carcinoma in a Colon Polyp on Routine Colonoscopy

Introduction: Colon polyp size contributes significantly to the assigned surveillance interval for prevention of colorectal carcinoma (CRC). Polyps ≤5-mm generally have a negligible risk of malignancy and colonic invasion (< 1%) and are often amenable to standard endoscopic resection. We present a patient undergoing her index average risk screening colonoscopy found to have rare colorectal primary signet ring cell carcinoma (SRCC) in a 5-mm polyp, necessitating surgery. Case Description/Methods: A 52-year-old Hispanic female with hypertension presented for her first routine screening colonoscopy. She denied a family history of gastrointestinal malignancy and was otherwise asymptomatic. A 5-mm, Paris Is sessile polyp was noted in the sigmoid colon (Image 1a) and was resected en-bloc with a cold snare. Histology showed poorly differentiated, invasive adenocarcinoma with signet ring cells (Image 1d). A staging abdominopelvic CT scan did not reveal pathologic lymphadenopathy or distant metastatic disease. Based on the histological findings and imaging, the patient returned for a flexible sigmoidoscopy to tattoo the lesion, and then underwent robotic-assisted laparoscopic sigmoid colectomy. There was no evidence of malignancy in the surgical pathology specimen. Discussion: SRCC is an epithelial malignancy with prominent intracytoplasmic mucin typically found in gastric glandular cells. Colorectal primary SRCC is a rare clinical entity accounting for 1% of all CRCs. It is often detected at an advanced stage, and therefore its overall prognosis is worse than other types of CRC. Risk factors for lymph node metastasis in pT1 polyps invading the submucosa include deep submucosal invasion for sessile lesions, poor differentiation, lymphovascular invasion, rectal location, tumor budding/mucinous tumors and the presence of either positive or indeterminate resection margins. The decision regarding surgical intervention after endoscopic resection of pT1 colorectal polyps is a complex one and depends upon the risk of residual cancer in the bowel wall and metastatic spread to adjacent or remote lymph nodes. Studies suggest that endoscopic resection before surgical resection of a high-risk pT1 CRC has no adverse effects on morbidity and mortality. In SRCC, factors such as advanced age, higher tumor grading and size, primary tumor location and nodal involvement are significantly correlated with a poor prognosis, thus, as seen in our patient, immediate colectomy provides the highest chance of survival.Figure 1.: A computed tomography scan of the abdomen exhibited diffuse fluid-filled dilatation of the colon with wall thickening and peri-colonic haziness, most prominent in the sigmoid colon and rectum. Chronic bilateral hydronephrosis and chronic cystitis were present as well.

S1750 A Novel Case of Crystal-Induced Colitis Presenting as Isolated Colonic Polyp

Introduction: Colonic polyps are routinely encountered during a colonoscopy and are usually hyperplastic or adenomatous. other less common polyps can be encountered and it is important for the gastroenterologists to be aware of. Crystal-associated colitis can be seen with medications such as kayexalate, sevelamer and bile acid sequestrants. It typically manifests as mucosal ulceration with lower GI bleeding. Here we present a case where the crystallized resins presented as an isolated, non ulcerated sessile polyp. Case Description/Methods: A 68-year-old male patient with known decompensated alcohol cirrhosis, iron deficiency anemia (hemoglobin of 8.5 at baseline) and chronic kidney disease presented with melena and hemoglobin of 6.9. He received a blood transfusion and was started on standard therapy for variceal bleeding. The esophagogastroduodenoscopy (EGD) revealed gastric antral vascular ectasia (GAVE) without active bleeding and were treated with argon plasma coagulation. Colonoscopy was normal apart from an 8 mm isolated sessile polyp within the ascending colon that was resected. Routine hematoxylin and eosin stain was reported as reactive colonic epithelium with entrapped crystals. This was an incidental finding noted on the colonoscopy and the culprit medication was cholestyramine which patient was receiving for treatment of hypercholesterolemia and cholestasis-associated pruritus. As the polyp was without ulceration, we do not believe that it contributed to the bleeding. He was treated by stopping the medication to promote mucosal healing and the polyp was resected in its entirety. Discussion: Crystallized resin material within a colon polyp is an uncommon finding on colonoscopy. It usually manifests with lower GI bleeding due to the crystals creating mucosal erosions. Our patient was asymptomatic, and the lower GI bleeding was attributed to GAVE. Given the wide variety of medications associated with crystal-induced colitis, we believe that both the gastroenterologist and GI pathologist should be aware of its different morphologies/phenotypes, including the less common isolated polyp presentation.Figure 1.: A computed tomography scan of the abdomen exhibited diffuse fluid-filled dilatation of the colon with wall thickening and peri-colonic haziness, most prominent in the sigmoid colon and rectum. Chronic bilateral hydronephrosis and chronic cystitis were present as well.

Anorectal and perineal pain

Anorectal and perineal pain Abstract. Anorectal pain is a common clinical challenge in the outpatient office. Anal fissures, anal venous thrombosis, proctitis or neoplasms are frequent etiologies for proctalgia. After exclusion of somatic disorders by diagnostic imaging and endoscopy, functional anorectal pain or pathologies like interstitial cystitits, chronic prostatitis, coccycodynia or pudendal neuralgia should be considered. The Rome IV criteria distinguish proctalgia fugax, a sharp paroxysmal pain lasting for maximum 30minutes, and the levator ani syndrom. Latter is characterized by a tender puborectal muscle on digital rectal examination and pain lasting for more than 30minutes. Treatment consists in reassurance, sitz bathes, topical vasodilators and anal massage. Biofeedback is a further option for levator ani syndrome. Painful palpation of the ox coccygis leads to the diagnosis of coccycodynia, a non-functional disorder. Therapy consists in anti-inflammatory medications, os coccygis mobilisation and infiltration therapy. Urologic chronic pelvic pain (chronic prostatitis and interstitial cystitis) as well as pudendal neuralgia, both neurogenic pelvic pain syndromes, can cause pain radiating into the after and perineum. The diagnosis and discrimination from functional rectal pain is difficult. Patients with neurogenic anorectal pain are best treated with anti-inflammatory medications, pain modulating antidepressives, anticonvulsives or local infiltration therapy. Interdisciplinary management of complex pain patients is mandatory.

Специфика психологического функционирования пациентов с интерстициальным циститом

Introduction. The use of psychotherapeutic strategies may be preferable for patients with interstitial cystitis, who do not respond to psychopharmacotherapy and even after somatotropic therapy. therapy, surgical interventions continue to experience uncomfortable sensations. However, many urologists, given the presence of the psychosocial etiology of cystitis in some patients, continue to advocate surgical treatment. Goal. Familiarizing urologists, gynecologists, and mental health professionals with the fact that cystitis consists of heterogeneous subtypes with corresponding pathogenic pathways, comorbid mental disorders, and emotional characteristics. Among these subtypes, the psychosocial phenotype should be distinguished, which has its own specifics, psychodynamics and requires appropriate complex treatment tactics. Materials and methods. 35 women from 25 to 48 years old suffering from recurrent cystitis for 7-12 years and 35 women without urological disorders. The following diagnoses are observed in patients: somatoform autonomic dysfunction of the genitourinary system (F45. 34); psychological factors in chronic recurrent cystitis (F54); recurrent depressive disorder, an episode of moderate severity (F33.1). The patients were examined using the questionnaire of the severity of psychopathological symptoms (SCL-90-R) and the scale of diagnosis of early maladaptive schemes (YSQ S3R). Results. The psychosocial phenotype of cystitis is represented by high somatization, the presence of obsessive-compulsive traits, interpersonal sensitivity, a tendency to develop depression and an anxiety spectrum of disorders. Among the maladaptive cognitive behavioral patterns, the following predominate: negativism/ pessimism, search for approval, feeling of vulnerability, lack of self-control, submission, self-sacrifice, feeling of abandonment and instability, distrust of other people. Conclusion. In addition to psychopharmacotherapy for the treatment of anxiety and depressive symptoms in patients with cystitis, psychotherapy aimed at minimizing difficulties in emotional awareness (alexithymia) and unresolved childhood trauma of relationships should be included in the treatment program. Multimodal psychodynamic psychotherapy and cognitive behavioral therapy can reduce symptoms, affect the immune and nervous systems, and the psychological well-being of patients with cystitis.

Ефективне лікування й профілактика часто рецидивуючої інфекції сечовивідних шляхів препаратом золотарника звичайного (Solidago virgaurea) Цисто-аурин®

Нами проведено дослідження клінічної та лабораторної ефективності, а також оцінка впливу на якість життя інтермітуючої терапії препаратом золотарника звичайного Цисто-аурин у 96 хворих на часто рецидивуючу інфекцію сечовивідних шляхів (ІСШ). Після отримання інформованої згоди хворі були розділені на три статистично однорідні групи. Протягом лікування пацієнтки всіх груп використовували стратегію поведінкової терапії та посткоїтальної профілактики. Пацієнтки групи А додатково отримували Цисто-аурин по 1 табл. 4 рази на день курсами по 15 днів кожного місяця протягом 6 місяців, групи В — той же препарат по 2 табл. 2 рази на день такими ж курсами, пацієнтки групи С (порівняння) спеціальної терапії не отримували. Упродовж дослідження отримані об’єктивні дані, що свідчать про вірогідне зниження числа рецидивів ІСШ на 92,3 і 73,3 % протягом 6 місяців лікування, залежно від кратності прийому препарату. Аналіз впливу досліджуваного препарату на лабораторні прояви часто рецидивуючої інфекції сечової системи показав позитивний ефект інтермітуючого режиму терапії щодо піурії, редукцію прозапальної активності та статистично вірогідне зменшення проявів запалення в сечовій системі. Ефективність редукції лейкоцитурії у хворих, які приймали препарат, становила 73,4 і 44,6 %, тобто лейкоцитурія була в 3,7 і 1,8 раза нижче вихідних значень. У той же час серед хворих групи С статистично значущої динаміки виявлено не було. Дискретна і кількісна оцінка впливу досліджуваного препарату на бактеріурію показала клінічно значущий і статистично вірогідний бактеріо­статичний ефект Цисто-аурину як в процесі лікування препаратом (на 41,0 і 27,6 % відповідно), так і в проспективному 6-місячному періоді спостереження після його прийому (на 30,3 і 18,0 % відповідно), що є важливим підтвердженням впливу препарату на персистенцію мікробів у сечовій системі. Структуризація антибактеріального ефекту щодо клінічно значущих уропатогенів підтвердила редукцію штамів E.сoli на 61,1 і 31,9 %, Klebsiella pneumoniae — на 33,1 і 17,1 %, P.mirabilis — на 19,1 і 12, 9 %, P.aeruginosa — на 21,1 і 14,1 %, Candida spp. — на 19,4 і 14,5 % відповідно. Оцінка впливу досліджуваного препарату на симптоматику рекурентного хронічного циститу (шкала UTISA) показала вірогідне зниження ключових клінічних симптомокомплексів рецидивної ІСШ: полакіурії (на 48,3 % в обох групах), імперативних позивів (59,8 і 30,1 %), болю й печіння (42,6 і 30,2 %), неповного випорожнення сечового міхура (53,8 і 30,9 %), а також інтегрального показника клінічних проявів патології (24,7 і 39,2 % відповідно). Динаміка показників якості життя, що пов’язана із здоров’ям (шкала SF-36), на тлі прийому препарату продемонструвала статистично значущу індукцію ключових доменів якості життя хворих на часто рецидивуючу ІСШ: психічного здоров’я (33,4 % проти 32,5 %) і кумулятивного показника загальної якості життя (19,6 % проти 14,6 % відповідно).

Late Changes in the Extracellular Matrix of the Bladder after Radiation Therapy for Pelvic Tumors.

Radiation therapy is one of the cardinal approaches in the treatment of malignant tumors of the pelvis. It leads to the development of radiation-induced complications in the normal tissues. Thus, the evaluation of radiation-induced changes in the extracellular matrix of the normal tissue is deemed urgent, since connective tissue stroma degradation plays a crucial role in the development of Grade 3–4 adverse effects (hemorrhage, necrosis, and fistula). Such adverse effects not only drastically reduce the patients’ quality of life but can also become life-threatening. The aim of this study is to quantitatively analyze the bladder collagen state in patients who underwent radiation therapy for cervical and endometrial cancer and in patients with chronic bacterial cystitis and compare them to the normal bladder extracellular matrix. Materials and methods: One hundred and five patients with Grade 2–4 of radiation cystitis, 67 patients with bacterial chronic cystitis, and 20 volunteers without bladder pathology were enrolled. Collagen changes were evaluated depending on its hierarchical level: fibrils and fibers level by atomic force microscopy; fibers and bundles level by two-photon microscopy in the second harmonic generation (SHG) mode; general collagen architectonics by cross-polarization optical coherence tomography (CP OCT). Results: The main sign of the radiation-induced damage of collagen fibrils and fibers was the loss of the ordered “basket-weave” packing and a significant increase in the total area of ruptures deeper than 1 µm compared to the intact sample. The numerical analysis of SHG images detected that a decrease in the SHG signal intensity of collagen is correlated with the increase in the grade of radiation cystitis. The OCT signal brightness in cross-polarization images demonstrated a gradual decrease compared to the intact bladder depending on the grade of the adverse event. Conclusions: The observed correspondence between the extracellular matrix changes at the microscopic level and at the level of the general organ architectonics allows for the consideration of CP OCT as a method of “optical biopsy” in the grading of radiation-induced collagen damage.

Эффективность применения пробиотиков в профилактике рецидивирующих инфекций нижних мочевыводящих путей и бактериального вагиноза

Introduction The literature data indicate that bacterial vaginosis (BV) increases the risk of development of lower urinary tract infections (LUTI). Thus, it is reasonable to assume that the use of probiotics, in particular Lactoginal, can be effective in preventing relapses of LUTI. Aim To study the efficiency of probiotics, particularly Lactoginal, for the prevention of recurrent LUTI and BV. Materials and methods A total of 120 women with chronic recurrent bacterial cystitis in the acute stage and concomitant bacterial vaginosis were randomized into two groups of 60 patients. In group 1, standard antibacterial therapy was used according to guidelines of professional societies. In group 2, vaginal probiotic Lactoginal was prescribed after standard treatment. Results The results obtained in this study correspond to the literature data. The additional use of probiotics in the complex therapy of chronic lower urinary tract inflammation contributed to the normalization of the lactobacilli concentration in 93% of cases, in contrast to standard antibacterial therapy, after which the normal flora was preserved only in 40% of cases. In addition, a reduction in the number of relapses of BV was seen. Moreover, it was found that in the group of patients treated with Lactoginal, there was 18.3% less recurrence of cystitis within 6 months than in the control group (p Conclusion The use of probiotics, in particular, Lactoginal vaginal capsules, in women with BV after antibacterial therapy contributes to a faster recovery and longer preservation of the normal vaginal flora, which allows to the prolongate the relapse-free period of both chronic bacterial cystitis and BV.

MP08-12 GUANYLATE CYCLASE-C AGONIST IW-3300 ATTENUATES CHRONIC COLONIC AND BLADDER HYPERSENSITIVITY IN A RAT MODEL OF PELVIC RADIATION INJURY

INTRODUCTION AND OBJECTIVE:Radiotherapy for pelvic cancers can lead to radiation-induced visceral organ injuries that develop into persistent chronic radiation proctitis, colitis, and cystitis. One...

PD09-11 POTENTIAL ROLE OF MICRO-ULTRASOUND IN THE DIFFERENTIATION BETWEEN MUSCLE-INVASIVE AND NON-MUSCLE INVASIVE BLADDER CANCER: A PROSPECTIVE ANALYSIS

You have accessJournal of UrologyBladder Cancer: Non-invasive I (PD09)1 Sep 2021PD09-11 POTENTIAL ROLE OF MICRO-ULTRASOUND IN THE DIFFERENTIATION BETWEEN MUSCLE-INVASIVE AND NON-MUSCLE INVASIVE BLADDER CANCER: A PROSPECTIVE ANALYSIS Pietro Diana, Giovanni Lughezzani, Alessandro Uleri, Nicola Frego, Roberto Contieri, Marco Paciotti, Vittorio Fasulo, Piergiuseppe Colombo, Nicolomaria Buffi, Alberto Saita, Paolo Casale, Rodolfo Hurle, and Massimo Lazzeri Pietro DianaPietro Diana More articles by this author , Giovanni LughezzaniGiovanni Lughezzani More articles by this author , Alessandro UleriAlessandro Uleri More articles by this author , Nicola FregoNicola Frego More articles by this author , Roberto ContieriRoberto Contieri More articles by this author , Marco PaciottiMarco Paciotti More articles by this author , Vittorio FasuloVittorio Fasulo More articles by this author , Piergiuseppe ColomboPiergiuseppe Colombo More articles by this author , Nicolomaria BuffiNicolomaria Buffi More articles by this author , Alberto SaitaAlberto Saita More articles by this author , Paolo CasalePaolo Casale More articles by this author , Rodolfo HurleRodolfo Hurle More articles by this author , and Massimo LazzeriMassimo Lazzeri More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001977.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Magnetic resonance imaging (MRI) has been proposed as a staging tool for bladder cancer (BC), but its use has been limited by its high costs and limited availability. Microultrasound (mUS) is a novel technology capable providing high-resolution images, which was initially developed for the diagnosis of PCa. In the setting of BC, a preliminary study has showed that mUS may be capable to differentiate the bladder wall layers, identify BC and differentiate between non-muscle invasive (NMIBC) and muscle-invasive BC (MIBC). The aim of this study is to confirm on a larger scale the potential role of mUS in the identification and characterization of BC. METHODS: This is an observational study of prospectively collected data performed in patients diagnosed with primary BC and scheduled for an endoscopic treatment. Micro-US was performed before transurethral resection (TUR) of bladder tumor using the ExactVu system with an EV29L 29-MHz side-fire transducer (Exact Imaging, Markham, Canada). The endpoints were to assess the diagnostic accuracy of mUS in identifying BC and in differentiating between NMIBC and MIBC comparing the mUS findings with the histopathological results. RESULTS: Between April 2018 and December 2020, we prospectively enrolled 94 consecutive patients with primary BC. Micro-US window was not acceptable in 10 patients and 2 patient presented with a tumor looking mass at both cystoscopy and abdominal US but histology was negative for bladder cancer showing chronic cystitis. In all the other 82 patients, mUS clearly identified the three bladder wall layers and the BC as heterogeneous structures protruding from the normal wall. The reported accuracy, sensitivity, specificity, and positive, and negative predictive values for mUS were 82.9%, 87.5%, 81%, 65.6%, and 94%, respectively. The ROC curve analysis for the mUS in detecting MIBC shows an AUC of 0.843 (CI 95% 0.746-0.940). CONCLUSIONS: These results confirm in a larger population the potential role of mUS to differentiate the bladder wall layers and reliably differentiate between NMIBC and MIBC in the great majority of patients. In consequence, mUS may represent a cheaper and less time-consuming alternative to mpMRI. Further comparative studies between mUS and MRI are still warranted to validate this imaging technique in the BC staging before its introduction in clinical practice. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e124-e124 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pietro Diana More articles by this author Giovanni Lughezzani More articles by this author Alessandro Uleri More articles by this author Nicola Frego More articles by this author Roberto Contieri More articles by this author Marco Paciotti More articles by this author Vittorio Fasulo More articles by this author Piergiuseppe Colombo More articles by this author Nicolomaria Buffi More articles by this author Alberto Saita More articles by this author Paolo Casale More articles by this author Rodolfo Hurle More articles by this author Massimo Lazzeri More articles by this author Expand All Advertisement Loading ...

Epidemiological features of chronic cystitis in the capital megapolis

The paper presents the results of the analysis for 2008–2017 of the prevalence and incidence of chronic cystitis in the adult population of Kiev based on the data of state, sectoral statistical reports (F.F. No. 12, 20). Two five-year periods are highlighted, the justification for which was the well-known territorial changes in the country; the corresponding indicators served as a comparison, which made it possible to identify the features of the dynamics of the studied processes.&#x0D; As a result of 10 years of observation, it was revealed that for the city of Kiev, which ranks second in the structure of the prevalence and incidence of chronic cystitis in Ukraine, a decrease in the number of registered patients (by 7.3%) with a simultaneous increase in newly diagnosed patients (by 15.6%; by 25.6% of men and 13.2% of women), in contrast to their overall growth in the country as a whole (by 0.4% and 2.8%, respectively). Prevalence rates (per 100 thousand) after an increase in the first five years are replaced by a decrease in the next period (621.2 to 687.9 versus 627.8 to 533.4). Among women, they were 3.5-4.8 times large; in 2017 – 862.8 versus 176.6 among men. The peculiarity of the incidence was manifested by its increase among women and men in 2013–2017 against the background of a decrease in the previous years; in 2017, the indicators per 100 thousand reached 88.5; among women – 127.2, men – 41.5.&#x0D; The observed situation of an increase in the incidence of chronic cystitis among the adult population of the capital with a simultaneous decrease in the prevalence allows us to evaluate it as a result of the provided adequate specialized care and, at the same time, indicates the need to study the causes, negative factors, as the basis for the improvement and implementation of disease prevention.

OC-0288 Preclinical study of chronic radiation cystitis and cell therapy treatment

OC-0288 Preclinical study of chronic radiation cystitis and cell therapy treatment

Personalized Metabolic Profile by Synergic Use of NMR and HRMS.

A new strategy that takes advantage of the synergism between NMR and UHPLC–HRMS yields accurate concentrations of a high number of compounds in biofluids to delineate a personalized metabolic profile (SYNHMET). Metabolite identification and quantification by this method result in a higher accuracy compared to the use of the two techniques separately, even in urine, one of the most challenging biofluids to characterize due to its complexity and variability. We quantified a total of 165 metabolites in the urine of healthy subjects, patients with chronic cystitis, and patients with bladder cancer, with a minimum number of missing values. This result was achieved without the use of analytical standards and calibration curves. A patient’s personalized profile can be mapped out from the final dataset’s concentrations by comparing them with known normal ranges. This detailed picture has potential applications in clinical practice to monitor a patient’s health status and disease progression.

Pseudomembranous Cystitis: An Uncommon Ultrasound Appearance of Cystitis in Cats and Dogs.

In veterinary medicine, pseudomembranous cystitis (PC) is a rare condition described only in cats. The purposes of this retrospective study were to describe ultrasound features of PC in cats and dogs, predisposing factors, comorbidities and outcomes. Cats and dogs with an ultrasonographic diagnosis of PC were included in the study. The bladder ultrasound findings that were recorded were: pseudomembranes’ characteristics, abnormalities of the bladder’s wall and content and anomalies of the pericystic peritoneal space. Ten cats and four dogs met the inclusion criteria. Four pseudomembrane adhesion patterns were described. The presence of pseudomembrane acoustic shadowing was observed in the 60% of cats. A total of 80% of the cats included were presented for urethral obstruction (UO) and/or had at least one episode of UO in the previous 2 months. Thirteen patients out of fourteen received only medical therapy, and all of them survived. PC is a rare disorder in cats and dogs and there are some ultrasonographic differences between the two species, suggesting a greater severity of the pathology in cats. Chronic cystitis and UO may have a potential role in the development of feline PC. Finally, the medical approach can be a non-invasive and effective approach for PC.

Characteristics of the Incidence and Prevalence of Chronic Cystitis Among the Male Population in Ukraine

The work is devoted to the dynamics of morbidity and prevalence of chronic cystitis among the male population of Ukraine for 10 years (2008–2017). The primary documents were the reported forms of official statistics. The special feature of the study was a comparative analysis of two periods of five-years. The approach was justified by the possibility to trace the nature and intensity of changes, and was also of interest in terms of known territorial changes in the country. It was found that among the total number of registered as well as first-time patients with chronic cystitis in Ukraine, a quarter of them were men. Over the years there has been a decrease in the number of cases. At the same time its rate among the latter is lower than among those registered, which is more pronounced in the last five years. This finding may suggest that the situation is likely to change in the near future towards an increase in the number of cases among men. The first three places in the number of men with chronic cystitis are occupied by the Southeastern, Western, Southern regions. The incidence and prevalence rates (per 100,000) among men are half as high as the corresponding rates among the adult population as a whole. The values of the latter have been decreasing over the years, while the incidence rate increased between 2013 and 2017. Each region has its own peculiarities, which are manifested both by the levels of width in the regions which make up their structure and by the nature of their dynamics. The first identified men with CC usually accounted for one quarter of the total number of cases. Each region is distinguished by the number of first-time offenders. The situation in Ukraine is defined by the Southeastern, Southern regions and Kiev, where the rates are higher than the Ukrainian average and aer increasing.