History Of Cystitis Research Articles

Urinary tract diseases and bladder cancer risk: a case–control study

The role of urinary tract diseases in bladder cancer (BC) etiology is not well established. To gain more insight on the role of urinary tract diseases in bladder cancer risk, we analyzed data from a large case-control study of bladder cancer. Epidemiological data were collected via in-person interview. Logistic regression analyses were used to estimate BC risk in association with prior history of urinary tract diseases. A total of 659 BC patients and 689 age-, gender-, -ethnicity matched controls were included in the analyses. Increased bladder cancer risk was associated with history of cystitis (OR = 1.52, 95% CI: 1.12, 2.06), however, the risk was attenuated for infections diagnosed >1 year from the time of BC diagnosis or interview. In contrast, a history of four or more kidney infections was associated with a significant decreased risk of BC (OR=0.17, 95% CI: 0.04, 0.69), and there was a significant dose-response relationship between number of episode and BC risk (P for trend = 0.002). The joint effect of smoking with cystitis, kidney infection, bladder stone, kidney stone, and prostate infection was studied but revealed no significant interaction between smoking and these urinary tract diseases. This study does not support the concept that urinary tract infections play a major role in the development of BC. Our study has the strength of collecting diagnosis time data of urinary tract diseases to allow analyzing the impact of timing of diagnosis between cancer and urinary tract diseases. This enables us to effectively address the issue of detection bias in case-controls studies of prior urinary diseases and BC.

Bladder tenderness as a physical sign for diagnosing cystitis in women

There are few semiotic signs for the diagnosis of cystitis. The costovertebral angle tenderness (CVAT) and vaginal exam have a likelihood ratio (LR) close to 1. Some patients experience a different pain when their bladder is compressed during the vaginal exam. The objectives of this study are to verify the accuracy of bladder tenderness for making the diagnosis of cystitis and if a past history of cystitis or recent sexual intercourse are risk factors for current cystitis. One hundred and ninety female volunteers = 15 years old with or without urinary symptoms were analyzed. The exclusion criteria were recent use of antibiotics and pregnancy. After a standard questionnaire a clean catch midstream urine sample was obtained. Then bladder tenderness was performed using the index finger inside the vagina. It was slid over the upper third of the anterior wall of the vagina compressing the bladder against the opposite hand placed on the suprapubic area. If the patient experienced any kind of pain the test was positive; otherwise it was negative. Urine analysis and culture were standard. (excerpt)

Nocturnal enuresis and overactive bladder in children: An epidemiological study

To investigate the prevalence and characteristics of nocturnal enuresis (NE) and to examine the prevalence of overactive bladder (OAB) symptoms in primary schoolchildren. After conducting an anonymous questionnaire survey about voiding habits and bowel habits in primary schoolchildren, a total of 6917 schoolchildren belonging to 11 primary schools were randomly enrolled in the survey. According to the International Continence Society, we defined NE as any involuntary loss of urine during sleep, occurring more frequently than once per month. Children with NE were subdivided into two groups, monosymptomatic NE (MNE) and enuretic syndrome (ES). To evaluate the characteristic differences of MNE and ES, we assessed the relationships between NE and voiding habits, and episodes of cystitis and constipation. Overactive bladder was defined as increased daytime frequency and/or urge urinary incontinence, and its prevalence was investigated. The response rate to the questionnaire was 76.4%. The prevalence of NE was 5.9% and was inversely related to increasing age. Monosymptomatic NE comprised 59.4% of NE cases. The annual spontaneous resolution rate of MNE was higher than that of ES. Increased daytime frequency, a history of cystitis and infrequent bowel habits were not related to MNE, but were significantly related to ES. The prevalence of OAB was 17.8%. Children with a history of cystitis had a significantly higher rate of OAB than children without it. Overall, NE and OAB were detected in 5.9% and 17.8% of primary schoolchildren, respectively. The link between NE and OAB symptoms, urinary tract infections and constipation deserves more attention.

GAP‐43 immunoreactivity of subepithelial and detrusor muscle nerve fibres in patients with refractory idiopathic detrusor overactivity

To determine the relative density of nerve fibres immunoreactive to growth associated protein-43 (GAP-43, an indicator of neuronal sprouting) in the subepithelium and detrusor of patients with idiopathic detrusor overactivity (IDO). To investigate the effect, if any, of age and previous recurrent bacterial cystitis on neuronal sprouting in such patients. A series of 18 women with urodynamically proven IDO (median age 62 years, range 39-85), who were refractory to treatment, underwent cystoscopy and cold cup biopsy. Controls (n=26, median age 65, range 32-79) were females without urgency/urge incontinence, undergoing cystoscopy for other indications. Recurrent proven bacterial cystitis (rUTI) was documented. Frozen sections were stained with specific antibodies to GAP-43 and protein gene product 9.5 (PGP, a general neuronal marker). The area represented by immunoreactive (ir) subepithelial or muscle nerve fibres was measured. The density of GAP-43ir and PGPir nerves did not differ significantly between IDO patients and controls, in either subepithelium or detrusor. The GAP-43ir nerve density (as percent of PGPir) increased significantly with advancing age amongst patients with IDO in the detrusor muscle but not in the subepithelium; density in controls was unaltered. In IDO patients with rUTI, a significant increase in GAP-43 (as percent of PGPir) was observed in the subepithelium. Although we found no evidence of increased neuronal proliferation in patients with IDO generally, the increase in GAP-43 with age and with previous cystitis history suggests that neuronal sprouting is important in some subsets of patients with IDO.

The Micturition Habits and Prevalence of Daytime Urinary Incontinence in Japanese Primary School Children

We assessed the prevalence of daytime urinary incontinence (DUI) and the daytime frequency of voiding by age and sex in neurologically normal children in primary school. We also investigated the association of DUI with background factors. We performed an anonymous questionnaire survey of DUI in primary school children. A total of 11 primary schools in Hiroshima City were randomly selected and 6,917 school children 7 to 12 years old were enrolled. DUI was defined as any involuntary leakage of urine during the daytime occurring more frequently than once monthly in the 6 months before the survey. Slight dampness of the child underwear was also regarded as DUI. The overall response rate was 76.4% of 6,917 school children. The prevalence of DUI was 6.3% and it was inversely related to age, decreasing from about 9% at age 7 to 2% at age 12 years. Children urinated about 5 or 6 times daily and increased daytime frequency occurred in 14.6% of all children. Daytime frequency of voids, history of cystitis and infrequent bowel habits had a statistically significant positive correlation with DUI. We found that the overall prevalence of DUI in primary school children was 6.3%, gradually decreasing with age. Increased daytime frequency, history of cystitis and infrequent bowel habits were significantly related to DUI. The link between DUI and daytime frequency, urinary tract infections and constipation deserves more attention.

Objective evidence of a high prevalence of renal damage in women with type 2 diabetes by technetium-99m DMSA renal cortex scan findings

Objectives To compare control women with men and women with type 2 diabetes mellitus (DM) for the prevalence and type of renal damage due to urinary tract infections (UTIs) using technetium-99m dimercapto-succinic acid ( 99mTc DMSA) renal scanning. Women with DM have UTIs more often than do women without DM. It is unknown, however, what the prevalence and type of renal damage due to UTI are in these women. Methods Three groups of patients: 28 control women without type 2 DM and a history of UTIs, 25 male patients with type 2 DM but without a history of UTIs, and 103 female patients with type 2 DM underwent 99mTc DMSA renal scan. The 103 women with type 2 DM were separated into three groups: 36 women without a history of UTIs, 34 patients with a history of cystitis only, and 33 with a history of pyelonephritis. Results All the control women and male patients with type 2 DM without a history of UTIs had normal 99mTc DMSA renal scan findings. However, 39.8% of women with type 2 DM had abnormal 99mTc DMSA renal scan findings. Women with type 2 DM without a history of UTI had a significantly lower prevalence of abnormal renal scan findings than did those with a history of cystitis only or pyelonephritis. In addition, the prevalence of abnormal renal scan findings was significantly higher in women with type 2 DM with pyelonephritis than in those with a history of cystitis only. Renal scars on 99mTc DMSA renal scans were found in women with type 2 DM and a history of pyelonephritis. Conclusions Compared with control women and men with type 2 DM, women with type 2 DM, especially if they had a history of UTIs, had a significantly higher prevalence of abnormal 99mTc DMSA renal scan findings.

Evaluation of the effect of spinal cord injury on serum PSA levels

Objectives. Prostatic structure and secretory activity are thought to be influenced by autonomic innervation of the prostate. Prostatic denervation is especially likely in patients with spinal cord injury (SCI) at the level of the cauda equina or the conus medullaris, where the peripheral nerve supply to the prostate may be specifically damaged. This may result in changes in serum prostate-specific antigen (PSA) levels, either directly or indirectly. Therefore, we measured serum PSA levels and also studied the influence of factors such as age, catheterization, duration of SCI, urinary tract infection, and history of cystitis on serum PSA values in men with SCI. Methods. Serum PSA levels were determined in 79 men with SCI (age older than 40 years) using banked sera by the Abbott MEIA PSA assay. Variables such as age, catheterization, duration of SCI, urine culture results, and history of cystitis were obtained from a review of patient records. Comparisons were made with a randomly selected, non-SCI control population of 501 men, 40 to 89 years old, who underwent serum PSA determination at our institution. Statistical comparisons were performed using the Mann-Whitney U test (nonparametric), since the populations were not normally distributed. Multivariate logistic regression analysis was used to assess the correlation between the various factors and the serum PSA levels in men with SCI. Results. No statistically significant differences were found in the median serum PSA values between the SCI group and the non-SCI control population. The age-specific PSA values obtained in the SCI group were also comparable to those reported for the general population at large. Age ( P <0.03) and the presence of a catheter ( P <0.0002) were the only two factors that were correlated with higher serum PSA values in the SCI group by regression analysis. Conclusions. Men with SCI tended to have serum PSA value distributions that were similar to those of the general population. However, those in the SCI group who had indwelling catheters were more likely to have higher PSA values at baseline, as were older men with SCI.

Cystitis associated with tiaprofenic acid: a survey of British and Irish urologists.

To quantify the extent and natural history of cystitis in relation to treatment with the non-steroidal anti-inflammatory drug (NSAID) tiaprofenic acid. Anonymous postal questionnaires were sent to all UK and Irish consultant urologists enquiring about their awareness of the association between tiaprofenic acid (Surgam) and cystitis, and the number, nature and clinical details of patients with the diagnosis. Of the 357 urologists, 45.7% replied; 37.4% of those who responded had had cases of NSAID-concurrent cystitis, 35.6% replied that they had no personal experience but were aware of the possibility of an adverse drug reaction and 27% were unaware of the possibility of NSAID-related interstitial cystitis. There were 108 reported cases of cystitis; 55 (51%) were women, 12 (11%) were men and gender was not stated in 41 (38%). The median duration of treatment was 59 weeks (range 6 weeks-4 years). Symptoms abated completely on stopping the drug in 86% of patients, resolving in a median of 14 weeks (range 7 days-2 years). In seven cases (10%), resolution was incomplete; 17 patients had undergone reconstructive urological surgery. Tiaprofenic acid has caused at least 108 cases of cystitis and several of these patients underwent extensive urological surgery based on the assumption that they were suffering from chronic interstitial cystitis. Most cases were reversible on withdrawal of tiaprofenic acid, but 10% of patients had residual symptoms. Tiaprofenic acid causes a higher incidence of cystitis than any other NSAID and its withdrawal from the market should be considered.

Attributable risks for bladder cancer in Northern Italy

Attributable risks (ARs) for bladder cancer were computed in relationship to cigarette smoking, coffee consumption, low intake of vegetables, history of cystitis, and occupation using data from a case-control study conducted in northern Italy between 1985 and 1993. Cases were 431 patients with histologically confirmed bladder cancer, and controls were 491 patients admitted to the same network of hospitals for acute, nonneoplastic, and non-urinary-tract diseases. Overall, the AR estimates were 49% for cigarette smoking, 23% for coffee consumption, 16% for low intake of vegetables, 12% for history of cystitis, and 4% for occupation. These five factors together explained more than 70% of bladder cancer cases in this population. The AR for cigarette smoking was significantly higher among men (56%) than women (17%), whereas coffee consumption, low vegetable intake, and cystitis were more important (but not significantly so) among women. These results suggest that more than 2500 of the 5400 deaths due to bladder cancer in Italy in 1990 could have been prevented by the elimination of cigarette smoking. With some appropriate dietary modification and intervention to prevent urinary tract infections and occupational exposures, this figure could approach 4000 avoidable deaths. Thus, bladder cancer could become a rare cause of death in this population.

Cystitis as a correlate of female urinary incontinence

The objectives of the research were to study the association between prevalent urge and stress urinary incontinence (UI) and a history of cystitis in adult females. A cross-section of the adult female population, aged 30–59 years, in the Municipality of Aarhus, Denmark, was studied, using self-reported data based on postal questionnaires. The sample consisted of 3114 women, out of whom 2613 (84%) delivered the information requested. The main outcome measures were period prevalence in 1987 of episodes of UI provoked by physical stress and UI associated with a feeling of urge, prevalence of experience of episodes of cystitis and UI related to cystitis in adult life, and prevalence of relative risks, as indicated by odds ratio (OR), of UI conditional on cystitis experience. Results indicated that the 1987 period prevalences of UI provoked by physical stress and UI associated with a feeling of urge were 15% and 9%, respectively. Forty-five per cent reported a history of cystitis and 10% of UI during episodes of cystitis. Both UI provoked by stress and UI associated with a feeling of urge were significantly correlated to cystitis (OR 2.1, P<0.0001, and 1.8, P<0.0001, respectively) and to UI during episodes of cystitis (OR 7.1, P<0.0001, and 5.7, P<0.0001, respectively). When corrected for the stress aspect, UI being associated with a feeling of urge showed no association of its own to a history of cystitis. However, stress and urge aspects were both correlated to the experience of UI during episodes of cystitis. The prevalence of experience of cystitis increased with increasing number of urologic (per operation OR 2.1, P<0.0001) and gynecologic operations (per operation OR 1.5, P<0.0001), e.g. curretage (per operation OR 1.2, P<0.001), but not with the number of abdominal operations or the number of childbirths. It was concluded that cystitis may be an important component of UI etiology. Stress and not urge UI seems to be the key type related to a history of cystitis in general. The experience of UI during cystitis is connected to both stress and urge UI. A history of cystitis may possibly itself by initiated by surgery.

Fosfomycin Trometamol versus Pipemidic Acid in the Treatment of Bacteriuria in Pregnancy

The Italian multihospital study of bacteriuria in pregnancy randomized 153 pregnant bacteriuric patients to receive fosfomycin trometamol (FT) as a single dose of 3 g and 138 such patients to receive conventional therapy with pipemidic acid (PA), 400 mg b.i.d. for seven days. The two groups were well matched for age, parity, pregnancy course, symptoms and past history of cystitis. Infecting organisms were eradicated in 147 (96%) of FT and 129 (94%) of PA patients. Similar recurrence rates occurred. Minimal side effects (mostly nausea and dyspepsia) occurred (9%) FT; 15% PA). Single-dose FT appeared equivalent to conventional treatment with PA.

Conservative Management of Chronic Interstitial Cystitis: Transcutaneous Electrical Nerve Stimulation and Transurethral Resection

Transcutaneous electrical nerve stimulation was used in a prospective series of 23 patients with classical interstitial cystitis. This treatment reduced pain in 18 patients and urinary frequency returned to normal in 8. Four women with a history of cystitis for 1 or 2 decades, had no symptoms during transcutaneous electrical nerve stimulation for 7 or more years and lesions disappeared or were hardly detectable. A 2 to 3-fold increase in bladder capacity with anesthesia also was registered. Complete transurethral resection of visible lesions in 30 patients resulted in initial disappearance of pain in all and a decrease in urinary frequency in 21. The mode of action of the 2 methods and registered complications are discussed.

Pivmecillinam treatment of chronic urinary tract infection

Twenty-eight patients with chronic urinary tract infections were treated with 400 mg pivmecillinam orally three times daily for 10 to 15 days. The diagnosis was confirmed by a history of cystitis or cystopyelitis four to six times annually, microscopy of urine sediment, and growth of pathogens in urine specimens obtained by suprapubic bladder puncture. Three days, three and six weeks after completion of therapy the success rates were 24/28, 20/28 and 19/28 respectively. Pivmecillinam was well tolerated. Two patients developed nausea and vomiting. Other side-effects were not observed. Pivmecillinam is a useful drug in the treatment of chronic urinary tract infections.

SERUM URIC ACID LEVELS IN WOMEN

Abstract. Women in the age strata 38, 46, 50, 54 and 60, 1462 women in all, were submitted to a population study in Göteborg, Sweden. Determination of serum uric acid levels was included in the study. The mean values of serum uric acid increased from 3.6 mg/100 ml in women aged 38 to 4.4 mg/100 ml in women aged 60. The rise in serum uric acid with age seemed to be unrelated to the menopause, as no differences were found between premenopausal and postmenopausal women of the same age. None of the 1462 women studied was found to suffer from clinical gout. When comparing women with high serum uric acid values and women in the general population of corresponding ages, no significant differences were found for joint complaints, serum creatinine, history of cystitis and/or pyelonephritis, history of renal calculi, alcohol consumption or socio‐economic status. Women on saluretic diuretics had significantly raised serum uric acid values compared to the general population of women. The urine concentrating capacity was decreased in hyperuricaemic women, both in those who took and in those who did not take saluretic diuretics. Women with high serum uric acid values had significantly higher values for body weight, subscapular skinfold and Hb. Serum uric acid was raised in women with arterial hypertension, women with a history suggesting angina pectoris and women with ECG changes suggesting ischaemic heart disease. However, these differences were probably caused by an overrepresentation of women on saluretic diuretics in these groups.