Interstitial Cystitis In Women Research Articles

Improved symptoms and signs of refractory interstitial cystitis in women after intravesical Nanofat plus platelet-rich plasma grafting: A pilot study.

Interstitial cystitis/bladder pain syndrome (IC/BPS) is characterized by bladder pain accompanied by irritative urinary symptoms, and typical cystoscopic and histological features. In this pilot study, we assessed the impact of lesion-targeted bladder injection therapy using a biocellular regenerative medicine on patients with refractory IC/BPS. The medicine, which was an autologous emulsified fat (Nanofat) and platelet-rich plasma (PRP) combination, was prepared intraoperatively. Six patients (aged 40-54 years), who completed a standard protocol of four consecutive treatments at 3-month intervals, were followed up at 6 months postoperatively. All patients (100%) reported marked (+3; +3 ~ -3) improvement of their overall bladder conditions. Mean bladder pain (from 8.2 to 1.7; range: 0 ~ 10), IC-related symptoms (from 18.5 to 5.7; range: 0 ~ 20), and bother (from 14.8 to 3.8; range: 0 ~ 16) improved significantly (p < 0.01). The normalization of bladder mucosal morphology with treatments was remarkable under cystoscopic examination, and no significant adverse events were found. The cultured mesenchymal stem cells from Nanofat samples of the six patients were verified in vitro. Our preliminary results suggest novel intravesical therapy with autologous Nanofat plus PRP grafting is safe and effective for refractory IC/BPS. Surgical efficacy might be attributed to an in vivo tissue engineering process.

Editorial Comment

No AccessJournal of UrologyAdult Urology1 Dec 2014Editorial Comment Joel Teichman Joel TeichmanJoel Teichman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.05.127AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, 192(6), p. 1685 References 1 : Neural upregulation in interstitial cystitis. Urology2007; 69: 24. Google Scholar 2 : Increased cannabinoid receptor 1-immunoreactive nerve fibers in overactive and painful bladder disorders and their correlation with symptoms. Urology2010; 75: 1514. Google Scholar 3 : The neural control of micturition. Nat Rev Neurosci2008; 9: 453. Google Scholar 4 : Bladder afferent signaling: recent findings. J Urol2010; 183: 1288. Link, Google Scholar 5 : Interstitial cystitis versus detrusor overactivity: a comparative, randomized, controlled study of cystometry using saline and 0.3 M potassium chloride. J Urol2006; 175: 566. Link, Google Scholar 6 : Gene expression profiling of mouse bladder inflammatory responses to LPS, substance P, and antigen-stimulation. Am J Pathol2002; 160: 2095. Google Scholar 7 : Pathophysiology of overactive bladder and urge urinary incontinence. Rev Urol2002; 4: S7. Google Scholar 8 : Increased prevalence of interstitial cystitis in women with detrusor overactivity refractory to anticholinergic therapy. Urology2005; 66: 702. Google Scholar © 2014 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 192Issue 6December 2014Page: 1685 Advertisement Copyright & Permissions© 2014 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joel Teichman More articles by this author Expand All Advertisement PDF downloadLoading ...

Efficacy of Daily Low-dose Sildenafil for Treating Interstitial Cystitis: Results of a Randomized, Double-blind, Placebo-controlled Trial—Treatment of Interstitial Cystitis/Painful Bladder Syndrome With Low-dose Sildenafil

To evaluate the efficacy of daily low-dose sildenafil for the treatment of nonulcer interstitial cystitis (IC) in women. Forty-eight women with a clinical diagnosis of IC from 3 medical centers were randomly assigned to treatment with daily low-dose sildenafil (25 mg, n=24) or placebo (n=24) for 3 months. The O'Leary-Sant IC symptom and problem indices, visual analog scale scores, and a micturition diary with the interval of micturition, the frequency of nocturia, and urgency episodes were recorded before treatment, every 2 weeks after the treatment until 3 months. Patient Overall Rating of Improvement in Symptoms was assessed and regarded as effective when the value was above 50%. The IC symptom and problem indices scores and urodynamic index were significantly improved in sildenafil treatment group as compared with placebo group and baselines at week 4, 6, 8, 10, and 12, as well as 3 months after treatment (P<.05). Urodynamic index including first desire to void, strong desire to void, and maximum cystometric capacity was significantly improved in sildenafil treatment group at week 12 and at 3 months after treatment (P<.05). The efficiency of treatment reached 62.5%. However, no significant change of the visual analog scale values was observed between 2 groups except at week 12 in the sildenafil treatment group (P<.05). All adverse events were mild to moderate and transient. Daily low-dose sildenafil is an easy, well-tolerated, and effective treatment for IC in women.

Marked improvement of pain from long term fibromyalgia with dextroamphetamine sulfate in a woman who failed to improve with conventional pharmacologic treatment

Purpose: To determine if treatment with the sympathomimetic amine dextroamphetamine sulfate, which has been so effective in treating a variety of pain syndromes, including severe pelvic pain and interstitial cystitis in women with the sympathetic neural hyperalgesia edema syndrome would also mitigate pain from fibromyalgia which was resistant to multiple therapies. Materials and Methods: Dextroamphetamine sulfate extended release capsules once daily was gradually increased to 25mg per day in a woman with treatment resistant fibromyalgia of 20 years duration. Results: Within a short time, the woman experienced dramatic relief of pain. Furthermore, her edema improved resulting in a 27 pound weight loss and her chronic fatigue improved. Conclusions: Fibromyalgia can be effectively treated with an innocuous dose of dextroamphetamine sulfate.

Efficient and cost-effective alternative treatment for recurrent urinary tract infections and interstitial cystitis in women: a two-case report.

Urinary tract infections (UTIs) are among the most common bacterial infections affecting women. UTIs are primarily caused by Escherichia coli, which increases the likelihood of a recurrent infection. We encountered two cases of recurrent UTIs (rUTIs) with a positive E. coli culture, not improving with antibiotics due to the development of antibiotic resistance. An alternative therapeutic regimen based on parsley and garlic, L-arginine, probiotics, and cranberry tablets has been given. This regimen showed a significant health improvement and symptoms relief without recurrence for more than 12 months. In conclusion, the case supports the concept of using alternative medicine in treating rUTI and as a prophylaxis or in patients who had developed antibiotic resistance.

Pharmacotherapy of Interstitial Cystitis in Women

Interstitial cystitis is a condition that affects the urinary bladder and may be more prevalent than commonly thought. Symptoms range widely in severity and typically include urinary urgency, frequency and pelvic pain. Therapies usually target the known pathophysiology of this condition. Oral agents commonly include bladder surface mucin analogues, antihistamines, narcotics, tricyclic antidepressants and anticonvulsants. Intravesical therapy is usually used as second-line treatment. Multiple forms of pharmacotherapy are often provided simultaneously to improve efficacy and time to response.

PREVALENCE OF INTERSTITIAL CYSTITIS SYMPTOMS IN WOMEN: A POPULATION BASED STUDY IN THE PRIMARY CARE OFFICE

We estimated the prevalence of urinary symptoms related to interstitial cystitis (IC) in women in a primary care practice and confirmed in the United States the results of a Finnish population based prevalence study. Every female patient presenting to our office for a routine office visit between January 9, 2004 and September 24, 2004 was evaluated for urinary symptoms using 2 validated surveys, namely the O'Leary-Sant (OLS) IC symptom and problem index, and the Pelvic Pain and Urgency/Frequency (PUF) patient symptom scale. Of the 1,218 women in the study group 13 (1.1%) reported severe symptoms and problems (12 or greater on the OLS survey), including 7 (0.6%) who met previously established criteria for probable IC. In the same population scores on the PUF questionnaire indicated that 154 women (12.6%) likely had IC. Based on previously published criteria for use of the OLS survey the prevalence of urinary symptoms corresponding to probable IC in our study population (575/100,000 or 0.57%, 95% CI 150 to 1,000) was similar to the 0.45% rate previously reported. However, the results of the PUF questionnaire indicated that the prevalence of IC in women may actually be much higher (12,600/100,000 or 12.6%, 95% CI 10,700 to 14,500). We suggest that the true prevalence of IC in women may be somewhere between these 2 extremes. Further investigation of these questionnaires as screening tools for IC is warranted. IC may be more common in women than previously reported.

Increased prevalence of interstitial cystitis in women with detrusor overactivity refractory to anticholinergic therapy

Objectives To estimate the prevalence of interstitial cystitis in women with detrusor overactivity refractory to anticholinergic medication using the potassium sensitivity test (PST). Methods Women with complaints of urinary frequency, urgency, and/or urge incontinence of 3 months’ duration or longer were referred to the urogynecology clinic. Between October 2003 and June 2004, 47 consecutive women were diagnosed with phasic, idiopathic detrusor overactivity after evaluation by history, physical examination, urinalysis, urine culture, urodynamic testing, and cystoscopy. Refractory detrusor overactivity was defined as a 50% or less improvement in urinary urgency, frequency, and/or urge incontinence episodes while taking anticholinergic medications. All women were offered the PST. Results All 47 women were included in the study; 18 (38.3%) had only detrusor overactivity incontinence and 29 (61.7%) also had concomitant urodynamic stress incontinence. Additionally, 19 women (40.4%) had pelvic pain. Of the 47 women, 31 agreed to undergo the PST. Of the 31 women, 25 had positive and 6 had negative PST result. Of the 31 women, 25 did not respond to therapy with one or more anticholinergic medications, and 24 (96%) of these 25 had had a positive PST. The remaining 6 women responded to treatment with oxybutynin, and only 1 (16.7%) had had a positive PST ( P = 0.0002). The odds ratio of a positive PST for women in whom anticholinergic therapy failed compared with women in whom it did not was 120.0 (95% confidence interval 6.4 to 2257.5; P = 0.0002). Conclusions These preliminary findings suggest that there is a high prevalence of interstitial cystitis in women with detrusor overactivity that does not respond to anticholinergic medication.

PREVALENCE OF CLINICALLY CONFIRMED INTERSTITIAL CYSTITIS IN WOMEN: A POPULATION BASED STUDY IN FINLAND

Interstitial cystitis (IC) is a clinical condition occurring predominantly in women that is characterized by irritative voiding symptoms, including urinary frequency, urgency and pain. To our knowledge its etiology is unknown and little is known about its occurrence. We evaluated the prevalence of IC in women in Finland. A total of 2,000 participants were randomly selected from the Finnish population register. Urinary symptoms were evaluated using the validated O'Leary-Sant IC symptom and problem index questionnaire. Women with moderate or severe symptom scores (7 or higher) without any urinary tract infection during the last month were invited to undergo clinical examination. Of the 1,331 respondents 32 had moderate or severe symptoms involving a suspicion of IC, of whom 21 underwent clinical evaluation. Three women were found to have probable IC and 4 had possible IC. Thus, the prevalence of clinically confirmed probable IC in women was 230/100.000 (95% CI 100 to 360) and that of possible/probable IC was 530/100.000 (95% CI 140 to 910). Considering the lack of information on 8 patients with urinary symptoms the corrected estimates were 300/100,000 (95% CI 120 to 770) and 680/100,000 women (95% CI 360 to 1,300), respectively. Our results based on a large and representative population, and clinically confirmed diagnoses indicate that IC is substantially more common than previously thought.

Doxycycline is effective in the treatment of urethral syndrome, chronic pelvic pain syndrome, sensory urgency, painful bladder syndrome and interstitial cystitis in women,

Doxycycline is effective in the treatment of urethral syndrome, chronic pelvic pain syndrome, sensory urgency, painful bladder syndrome and interstitial cystitis in women,

Diagnosing interstitial cystitis in women with chronic pelvic pain

OBJECTIVE:To evaluate the Interstitial Cystitis Symptom Index and Problem Index as a screening tool for interstitial cystitis, and to estimate the prevalence and risk factors for interstitial cystitis in women with chronic pelvic pain.METHODS:Forty-five women scheduled to undergo laparoscopy for chronic pelvic pain were recruited. Women were questioned about lower urinary tract symptoms, administered the Interstitial Cystitis Symptom Index and Problem Index, and rated pain symptoms on a 0–10 visual analogue scale. Cystoscopy with hydrodistension and bladder biopsy was performed at the time of laparoscopy. Interstitial cystitis was diagnosed if women had a combination of: 1) urgency, 2) frequency or nocturia, and 3) positive cystoscopic findings.RESULTS:Seventeen women (38%) were diagnosed with interstitial cystitis. A score of 5 or more on the Symptom Index had 94% sensitivity (95% confidence interval [CI] 71%, 99.8%) and 93% negative predictive value (95% CI 68%, 99.8%) in diagnosing interstitial cystitis. On multivariable analysis, an elevated Symptom Index score of 5 or more (odds ratio [OR] 9.4; 95% CI 1.01, 88.1) and an elevated dyspareunia score of 7 or more (OR 5.5; 95% CI 1.10, 27.1) were risk factors for interstitial cystitis.CONCLUSION:In our sample of women with chronic pelvic pain, the prevalence of interstitial cystitis was 38%. The Interstitial Cystitis Symptom Index was a useful screening tool. Independent risk factors for the diagnosis of interstitial cystitis were an elevated Symptom Index score and an elevated dyspareunia pain score. For women with chronic pelvic pain, screening for interstitial cystitis should be performed.

Diagnosing Interstitial Cystitis in Women With Chronic Pelvic Pain

Diagnosing Interstitial Cystitis in Women With Chronic Pelvic Pain

Prevalence of Symptoms Related to Interstitial Cystitis in Women: A Population Based Study in Finland

Interstitial cystitis is a chronic inflammatory bladder disease. Despite intensive research its prevalence, etiology, diagnosis and appropriate treatment remain elusive. We estimated the prevalence of urinary symptoms related to interstitial cystitis in women in Finland. We randomly selected 2,000 study participants 18 to 71 years old from the Finnish population register. The prevalence of urinary symptoms was evaluated using the validated O'Leary-Sant interstitial cystitis symptom and problem index questionnaire, which was mailed to subjects. Women with high (12 or greater) symptom and problem scores, including nocturia 2 or greater, pain 2 or greater, and excluding urinary infection and pregnancy, were considered most likely to have interstitial cystitis. The response rate after 2 mailings was 67.2% (1,343 respondents). After further exclusions 1,331 women (66.6%) comprised the final study group. Of these 1,331 respondents 11 (0.8%) reported severe symptoms and problems (12 or greater), including 6 (0.45%) who fulfilled the criteria for probable interstitial cystitis. The prevalence of urinary symptoms corresponding to probable interstitial cystitis is 450/100.000 (95% confidence interval 100 to 800), which is an order of magnitude higher than previously reported.

Prevalence of Symptoms Related to Interstitial Cystitis in Women: A Population Based Study in Finland

Prevalence of Symptoms Related to Interstitial Cystitis in Women: A Population Based Study in Finland

Understanding chronic pelvic pain syndrome.

Patients with non-inflammatory chronic pelvic pain syndrome, the largest group of prostatitis patients according to the US National Institute of Diabetes and Digestive and Kidney Diseases classification, are characterized by the absence of objective findings. Nothing thus links the symptoms of this disease to the prostate or other male organs in particular. For this reason, observations on interstitial cystitis in women are of interest to understand the chronic pelvic pain syndrome. New information from studies on the inflammatory response in expressed prostatic secretion in patients with chronic pelvic pain syndrome and in bladder tissue from patients with interstitial cystitis indicates that complex systems on the cytokine gene expression level may be operating in these diseases. Research findings point to a common denominator at the level of molecular biology that might explain how the symptoms of chronic pelvic pain syndrome and interstitial cystitis can be precipitated by pathogens, inflammatory reactions and even neurological mechanisms. The initial clinical trial reports of drugs that modulate the inflammatory response in interstitial cystitis are met with great interest.

Interstitial Cystitis: Diagnosis and Treatment

Interstitial cystitis is a chronic disease characterized by urinary urgency, voiding frequency, and suprapubic pain, in the presence of sterile and cytologically normal urine. Various diagnostic criteria have been proposed, but the diagnosis of interstitial cystitis is essentially still one of exclusion. Health care providers need to consider the diagnosis of interstitial cystitis in women presenting with irritative voiding complaints or suprapubic pain, and provide appropriate patient education and management options for patients with this disease. The symptoms of interstitial cystitis create substantial psychological, social, and hygienic problems, and diminish the quality of life of the patient and her family. Treatment should address the relief of symptoms, the regeneration of the bladder lining, and the restoration of the quality of life. Pharmacological, surgical, and supportive therapies exist to achieve these objectives and are probably most effective when used in combination.

Diagnosing Interstitial Cystitis in Women with Chronic Pelvic Pain

Diagnosing Interstitial Cystitis in Women with Chronic Pelvic Pain

Diagnosing interstitial cystitis in women with chronic pelvic pain

Objective: To determine the prevalence of interstitial cystitis (IC) and to evaluate the Interstitial Cystitis Symptom and Problem Index as a screening tool for IC in women with chronic pelvic pain. Methods: Forty-five women scheduled to undergo laparoscopy for chronic pelvic pain were recruited. The women were questioned about lower urinary tract symptoms; the Interstitial Cystitis Symptom and Problem Index was administered to them, and they rated pain symptoms on a 0–10 visual analogue scale. Cystoscopy with hydrodistention and biopsy were performed at the time of laparoscopy. Interstitial cystitis was diagnosed if women had a combination of 1) urgency, 2) frequency or nocturia, and 3) positive cystoscopic findings. Results: Seventeen women (38%) were diagnosed with IC. A score of 5 or more on the Symptom Index had a sensitivity of 94%, specificity of 50%, positive predictive value of 53%, and a negative predictive value of 93% for the diagnosis of IC. On univariate analysis, significant risk factors were a Symptom Index score of 5 or more, a dyspareunia score of 7 or more, and a history of more than one urinary tract infection per year. On multivariate analysis, the Symptom Index score (odds ratio = 9.44, 95% CI = 1.01–88.1) and the dyspareunia score (odds ratio = 5.47, 95% CI = 1.10–27.1) remained risk factors for IC. Conclusion: In our study of women with chronic pelvic pain, the prevalence of IC is 38%, and the Symptom Index is a useful screening tool for IC. In these women, when the Symptom Index score is 5 or more, IC should be suspected, and cystoscopy with hydrodistention should be considered.

Surgical treatment of interstitial cystitis in women.

Interstitial cystitis is a clinical entity that has been known for a century, but its pathophysiology remains largely unknown and the optimal treatment is a matter of ongoing discussion. A successful strategy for treatment relies on precise appraisal of symptoms, clinical findings and histology, as well as on the patient's individual personality. The least invasive treatment possible should be chosen, and only after conservative options have been exhausted should a surgical solution be considered. In this respect, anatomical bladder capacity plays an important role. A large capacity indicates the potential for conservative treatment and may be regarded as a negative predictor for the outcome of orthotopic bladder substitution. In contrast, a small anatomical capacity is unlikely to respond to conservative therapy, but is associated with a high probability of successful orthotopic bladder substitution.

THE DIAGNOSIS OF INTERSTITIAL CYSTITIS REVISITED: LESSONS LEARNED FROM THE NATIONAL INSTITUTES OF HEALTH INTERSTITIAL CYSTITIS DATABASE STUDY

The lack of a precise working definition of interstitial cystitis may have resulted in the de facto use of the National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK) "research" definition by clinicians. We evaluated these strict criteria in light of the broader inclusion criteria for patients evaluated in the Interstitial Cystitis Database study to determine their utility in clinical practice as a useful basis for the diagnosis of interstitial cystitis. A total of 379 women who completed screening for the Interstitial Cystitis Database before January 1, 1996 met the basic criteria of urinary frequency, urgency or pain for at least 6 months in duration without a diagnosable etiology. Of these patients 148 underwent cystoscopy and hydrodistention of the bladder as a part of the evaluation. All patients were followed for a minimum of 1 year. Comparisons were made between patients judged to have a clinical diagnosis of interstitial cystitis and those who met the NIDDK research definition of the syndrome. Almost 90% of patients potentially meeting NIDDK criteria are believed by experienced clinicians to have interstitial cystitis, confirming the research value of these criteria in defining a homogeneous population for study. However, strict application of NIDDK criteria would have misdiagnosed more than 60% of patients regarded by researchers as definitely or likely to have interstitial cystitis. The NIDDK criteria are too restrictive to be used by clinicians as the diagnostic definition of interstitial cystitis.