Interstitial Cystitis Problem Index Research Articles

Modified botulinum toxin type A injections improve symptoms associated with interstitial cystitis/bladder pain syndrome in women: a retrospective cohort study

ObjectiveTo investigate the efficacy and safety of modified botulinum toxin type A (BoNT-A) injections (with additional periurethral injection [PUI] of BoNT-A) for the treatment of interstitial cystitis/bladder pain syndrome (IC/BPS). MethodsThis single-center, retrospective cohort study included 52 adult female patients with IC/BPS, with 24 patients receiving conventional BoNT-A injections and 28 receiving modified BoNT-A injections. The primary outcome measure was patient-reported global response assessment (GRA). Secondary outcomes included daytime frequency, nocturia, number of urinary urgency episodes in the voiding diary, pain visual analog score, O'Leary-Sant Interstitial Cystitis Symptom Index and Interstitial Cystitis Problem Index, pelvic pain and urgency/frequency scores, risk factors for recurrence, and postoperative recurrence-free time. ResultsThe median duration of follow-up was 16.0 months (interquartile range 11.75–21 months). Patients who underwent modified BoNT-A injections showed significant improvement in postoperative GRA, symptom questionnaires, and pain assessment compared with those who underwent conventional surgery. A statistically significant difference was observed between the two groups in terms of recurrence-free time (12.5 vs. 18.0 months, P=0.02). Subgroup analysis suggested that additional PUI of BoNT-A was more effective in patients with combined severe periurethral pain. No serious complications occurred in both groups, and all minor postoperative complications were temporary. ConclusionsModified BoNT-A injection is an effective treatment for IC/BPS that significantly reduces pain and improves voiding symptoms. It is particularly effective in patients with combined periurethral pain. In such patients, PUI of BoNT-A should be added to the routine intravesical injection of BoNT-A.

Treatment of chronic post-radiation cystitis with trans-urethral amniotic bladder therapy appears durable at 9 months: A clinical study.

Chronic radiation cystitis (CRC) develops after radiation therapy and can present with symptoms like urinary frequency, urgency, pelvic pain, and nocturia. We have previously reported that amniotic bladder therapy (ABT) provides symptomatic improvement in refractory CRC patients for up to 3 months. Herein, we evaluated the durability of ABT up to 6 months. CRC patients recalcitrant to previous treatments received ABT comprised of intra-detrusor injections of 100 mg micronized AM diluted in 10 mL 0.9% preservative-free sodium chloride. Clinical evaluation and questionnaires (Interstitial Cystitis Symptom Index (ICSI), Interstitial Cystitis Problem Index (ICPI), Bladder Pain/Interstitial Cystitis Symptom Score (BPIC-SS), Overactive Bladder (OAB) Assessment Tool, SF-12 Health Survey) were repeated at pre-op and 2, 4, 8, 12, 16, 20, 24, and 36 weeks post-injection. Five consecutive patients with a mean age of 64.4 ± 20.1 years with a median CRC duration of 10 years were included and followed for 6 months. After ABT, the lower urinary tract symptoms improved as early as 2 weeks and were maintained up to 20 weeks. BPIC significantly improved from 36.6 ± 1.1 at baseline to 12.6 ± 1.5 at 16 weeks and 13.8 ± 2.9 at 20 weeks. At 24 and 36 weeks, the improvement was maintained in four (80%) of the five patients (BPIC = 13.8 ± 1.0). Uroflow assessment showed voiding volume improved two-fold in four of the five patients at 24 weeks compared to baseline. Our data suggest that a significant number of CRC patients may have durable benefit after ABT. Despite this, some of them can show symptoms rebound at 24 weeks.

Effects of onabotulinum toxin-A injection on sexual function in women with refractory interstitial cystitis/bladder pain syndrome: A prospective study.

To determine the effect of intravesical onabotulinum toxin-A (BoNT-A) treatment on sexual functions in female patients with refractory interstitial cystitis/bladder pain syndrome (IC/BPS). Female patients with IC/BPS refractory to previous treatments were included in the study between January 2020 and April 2022. Patients were treated with the trigone-sparing injection (Group 1) or trigone-included injection (Group 2) techniques. 100 Units of BoNT-A was applied submucosally on 20 different points. The patients were evaluated with visual analog scale (VAS), O'Leary-Sant Interstitial Cystitis Symptom Index (ICSI), Interstitial Cystitis Problem Index (ICPI), Female Sexual Function Index (FSFI) questionnaires, 3-day voiding diary, uroflowmetry, and post-voiding residual volume analysis in the preoperative period, as well as on the 30th and 90th days postoperatively. For the repeated measurements, analysis of variance was used to assess the time-dependent variation across groups. The baseline FSFI score of the patients was 15.96 ± 3.82. Following the treatment, the FSFI scores were 22.43 ± 4.93 and 24.41 ± 5.94 on the 30th and 90th days, respectively (p < .001). We observed statistically significant improvement in all FSFI subdomains (p < .05). Statistically significant improvements with treatment on ICSI, ICPI, and VAS scores were achieved (p < .05). Preoperative FSFI scores were similar in Group 1 and Group 2 (p = .147). While the preoperative FSFI scores were 17.00 ± 3.73 and 14.84 ± 3.72 for Group 1 and Group 2, respectively, the scores after the treatment were 22.85 ± 5.01 and 21.98 ± 5.01 on the 30th day, and 24.62 ± 6.06 and 24.19 ± 6.05 on the 90th day postoperatively. Significant improvement was observed in FSFI scores with treatment, and no difference was observed between the two groups in terms of treatment response (p = .706). Intravesical BoNT-A injection in the treatment of women with refractory IC/BPS improves sexual functions. It also significantly improves pain and symptom scores. Both trigone-sparing and trigone-including injections are similarly safe and effective.

Obstructive sleep apnea and bladder pain syndrome/interstitial cystitis in women.

The relationship between obstructive sleep apnea (OSA) and bladder pain syndrome/interstitial cystitis (BPS/IC) remains uncertain. Therefore, this study aimed to compare the frequency of BPS/IC seen in women diagnosed with OSA and in women without OSA. The study included a patient group of women with OSA and a control group of women without OSA. All the study participants were administered the Berlin Questionnaire, Epworth Sleepiness Scale, Interstitial Cystitis Symptom Index (ICSI), and the Interstitial Cystitis Problem Index (ICPI). Differences between the women with OSA and thecontrol group were examined. The study sample consisted of 46 women with OSA and 46 controls.No significant difference was determined between the OSA and control groups concerning age and body mass index (p = 0.810, p = 0.060, respectively). The ESS was greater in the OSA group than in the control group (p = 0.007).The median (IQR) ICSI was8 (4-11.25) in women with OSA and5 (1.75-7.15) in controls (p < 0.001). The median (IQR) ICPI was7 (6.00-10.25) in women with OSA and6(1.75-8.00) in controls (p < 0.001). CONCLUSIONS: The ICSI symptoms and subsequent problems in daily life caused by the symptoms (ICPI) were experienced at a higher rate in patients withOSA than in the control group. There is an association between BPS/ICand OSA.

Urinary ATP may be a biomarker of interstitial cystitis/bladder pain syndrome and its severity.

Urinary tract cells respond to bladder distension by releasing adenosine triphosphate (ATP). Patients with interstitial cystitis/bladder pain syndrome (IC/BPS) exhibit elevated urinary ATP levels compared to asymptomatic controls. This study aimed to evaluate the potential of urinary ATP as a non-invasive biomarker for IC/BPS and its correlation with symptom severity. We included 56 patients diagnosed with IC/BPS and 50 asymptomatic controls. Urine samples were collected from both groups. Urinary ATP levels were quantified using the luciferin-luciferase bioluminescence method. The severity of IC/BPS symptoms was assessed using the visual analogue score (VAS), Interstitial Cystitis Symptom Index (ICSI), and Interstitial Cystitis Problem Index (ICPI) from the O'Leary-Sant score. We specifically examined the correlation between symptom scores and urinary ATP levels in IC/BPS patients. Urinary ATP levels were significantly higher in IC/BPS patients compared to the control group (P < 0.0001). There was a significant positive correlation between urinary ATP concentrations and VAS, ICPI, and ICSI scores among IC/BPS patients (P < 0.0001). The threshold value for ATP concentration was set at 56.6 nM, with an area under the receiver operating characteristic (ROC) curve of 0.811 (95% CI 0.730 - 0.892). Our findings indicate that IC/BPS patients excrete elevated amounts of ATP in their urine. This suggests that urinary ATP might serve as a non-invasive biomarker for IC/BPS, with a predictive potential in terms of symptom severity.

Early three-month report of amniotic bladder therapy in patients with interstitial cystitis/bladder pain syndrome.

Interstitial cystitis/bladder pain syndrome (IC/BPS) is characterized by symptomatic frequency and urgency, as well as chronic pelvic pain. Disruption of the urothelial barrier is closely associated with IC/BPS. As amniotic membranes (AM) offer capabilities of wound healing in many other fields of medicine, likewise amniotic bladder therapy (ABT) may offer capability of urothelial healing in IC/BPS. Under general anesthesia, 10 consecutive IC/BPS patients received intra-detrusor injections of 100mg micronized AM (Clarix Flo) diluted in 10ml 0.9% preservative-free sodium chloride. Clinical evaluation and questionnaires (Interstitial Cystitis Symptom Index (ICSI), Interstitial Cystitis Problem Index (ICPI), Bladder Pain/ Interstitial Cystitis Symptom Score (BPIC-SS), Overactive Bladder Assessment Tool, and SF-12 Health Survey) were repeated at pre-op and 2, 4, 8 and 12weeks post-op. Ten females (47.4 ± 14.4years) who had recalcitrant IC/BPS for 7.8years (5.2-12.1years) received injection of micronized AM uneventful in all cases. After treatment, voiding symptoms and bladder pain significantly improved from pre-injection to 3months. BPIC-SS significantly decreased from 37.4 ± 0.70 at baseline to 12.2 ± 2.90 at 3months (p < 0.001). This corresponded to a significant improvement in their overall physical and mental quality of life. No adverse events occurred related to micronized AM injections, such as UTIs or acute urinary retention. ABT could be an innovative treatment option for IC/BPS patients in terms of improving clinical symptoms based on preliminary outcomes at 3months. Further studies are warranted to confirm the usefulness of ABT in patients with IC/BPS and to determine the duration of the effect.

PD05-03 BLADDER-DIRECTED VERSUS PELVIC FLOOR THERAPY IN WOMEN WITH INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME: PRELIMINARY RESULTS

You have accessJournal of UrologyCME1 Apr 2023PD05-03 BLADDER-DIRECTED VERSUS PELVIC FLOOR THERAPY IN WOMEN WITH INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME: PRELIMINARY RESULTS Bernadette Zwaans, Lydia Kosovich, Larry Sirls, Jason Gilleran, Christoper Smith, Priya Padmanabhan, Michael Chancellor, and Kenneth Peters Bernadette ZwaansBernadette Zwaans More articles by this author , Lydia KosovichLydia Kosovich More articles by this author , Larry SirlsLarry Sirls More articles by this author , Jason GilleranJason Gilleran More articles by this author , Christoper SmithChristoper Smith More articles by this author , Priya PadmanabhanPriya Padmanabhan More articles by this author , Michael ChancellorMichael Chancellor More articles by this author , and Kenneth PetersKenneth Peters More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003229.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Interstitial cystitis/bladder pain syndrome (IC/BPS) symptoms appear bladder related, though little solid evidence exists linking IC/BPS symptoms to dysfunctional bladder epithelium unless ulcers are present. Growing evidence suggests IC/BPS may be a more diffuse syndrome. The study objective is to compare IC/BPS symptom improvement in pelvic floor versus bladder directed therapies. METHODS: Women 18 to 85 years with history of IC/BPS were randomized to one of two treatment arms: 1. Pelvic Floor Physical Therapy (PFPT), 2. Bladder directed instillation of lidocaine, heparin sulphate, sodium bicarbonate, and Kenalog. All participants received twice weekly treatments for 8 consecutive weeks. Symptom improvement was assessed using 3-day voiding diary, pain assessment, and validated questionnaires: global response assessment (GRA), Interstitial cystitis symptom index (ICSI) and Interstitial cystitis problem index (ICPI), at baseline, treatment mid- and end-points (V8 and V17), and 6 months follow-up (V18). Statistical analysis was performed using ANOVA followed by Dunnett’s multiple comparison. RESULTS: 31 women were enrolled and randomized to PFPT (n=15) or Instillation (n=16) arm with average age of 46.8 and 48.7 respectively. By end of treatment 67% in PFPT versus 54% in instillation group reported significant improvement of symptoms (GRA). Urinary frequency was significantly reduced in PFPT group at all time points (Figure 1) and was resolved or improved in 75% of patients in PFPT compared to 33% in instillation group. Both treatments significantly improved Maximum pelvic pain, but reduction in pain was no longer significant in PFPT group by V18 (Figure 1). Pain Catastrophizing Scale scores followed the same trend. Urgency did not improve with either treatment. ICSI and ICPI scores were significantly reduced by V8 and remained constant up to V18. No severe adverse events were reported. Four patients developed urinary tract infections during treatment, 1 in PFPT and 3 in instillation group. CONCLUSIONS: Both treatments significantly improved IC/BPS symptoms, with patients in PFPT reporting higher GRA scores and frequency improvement. In contrast, instillation appeared superior in reducing maximum pelvic pain long-term. Source of Funding: DoD clinical research grant (W81XWH 16-10) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e149 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bernadette Zwaans More articles by this author Lydia Kosovich More articles by this author Larry Sirls More articles by this author Jason Gilleran More articles by this author Christoper Smith More articles by this author Priya Padmanabhan More articles by this author Michael Chancellor More articles by this author Kenneth Peters More articles by this author Expand All Advertisement PDF downloadLoading ...

Relationship between sexual and bladder dysfunction in women consuming ketamine.

Although ketamine has become the second most popular recreational drug in Taiwan, there have been very few reported studies that investigated female sexual dysfunction (FSD) in ketamine abusers (KAs). We sought to compare the difference between street and hospital KAs and explored the risk factors for FSD and lower urinary tract symptoms (LUTS) in KAs. In this cross-sectional study, female KAs aged 18 years or older were invited to complete anonymous questionnaires during an educational course provided by the departments of substance control and prevention of the local government or under the instruction of medical providers at a urology clinic. Data were reported as median (IQR) and OR and analyzed with commercial statistical software. Key outcome measurements were illicit drug use history, FSD symptoms, and LUTS severity. We included 139 women (104 street and 35 hospital KAs) with a median age of 27.08years. FSD was reported in 76% of all the participants (street vs hospital KAs, 68% vs 97%, P < 0.001). LUTS (Interstitial Cystitis Symptom Index [ICSI] + Interstitial Cystitis Problem Index [ICPI] ≥12) was found to be a significant risk factor for FSD in KAs. More hospital KAs (71%) reported experiencing LUTS (ICSI + ICPI ≥12) than street KAs (8%, P < 0.001). Longer duration of ketamine use (≥36months) and mild to severe psychological symptoms (5-item Brief Symptom Rating Scale [BSRS-5] ≥6) were significant risk factors for LUTS. Sexual problems among KAs should not be overlooked since more severe sexual dysfunction was observed in patients reporting LUTS. To our knowledge, the present study is the largest study using validated and reliable questionnaires to examine FSD in KAs and also the first study to include street KAs. The main limitation of this study is using self-report questionnaires as they are subjective and susceptible to human errors and recall biases. Women who abused ketamine and reported experiencing LUTS were found to be more likely to have FSD.

Sexual dysfunction in women with interstitial cystitis/bladder pain syndrome: Do onabotulinum toxin-A injections improve sexual function?

Interstitial cystitis/bladder pain syndrome (IC/BPS) has a negative impact on female sexual function. We aimed to evaluate the effect of intravesical botulinum toxin-A (BTX-A) injection on the improvement of sexual dysfunction and urinary symptoms using the multi-domain female sexual function Index (FSFI), interstitial cystitis symptom index (ICSI), and interstitial cystitis problem index (ICPI). The data of the 23 patients (study group) who received intravesical BTX-A with the diagnosis of IC/BPS were reviewed. Twenty-three age-matched healthy, sexually active women were determined as the control group. Patients received 100 U BTX-A submucosally injections, including the trigone. One hundred units of BTX-A were diluted to 20 cc0.9% saline, and 1 cc was then applied submucosally on 20 different points of the bladder wall (5 U/1 mL per site). The study group was asked to fill out FSFI, ICSI,andICPI, as well as the visual analog scale (VAS) and bladder diary before and 3 months after the treatment. Patients in the control group completed the same questionnaires once. The pre- and post-treatment questionnaire scores were compared in the study group. The study group's data were also compared to the control group. Compared to the pretreatment period, the study group showed statistically significant improvement in the total FSFI score and each domain of the FSFI after BTX-A injection. The mean total FSFI score and three domains of FSFI (desire, lubrication, pain) reached to the score of the control group following BTX-A injection. Statistically significant improvements were also shown in scores of ICSI, ICPI, and VAS. (p < 0.05). IC/BPS is associated with a very high incidence of sexual dysfunction. Intravesical BTX-A injection may provide significant improvement in sexual dysfunction in women with IC/BPS.

Comparing online crowdsourcing with clinic patient enrollment: Findings from the IP4IC Study on interstitial cystitis/bladder pain syndrome.

Interstitial cystitis/bladder pain syndrome (IC/BPS) manifests as urinary symptoms including urgency, frequency, and pain. The IP4IC Study aimed to establish a urine-based biomarker score for diagnosing IC/BPS. To accomplish this objective, we investigated the parallels and variances between patients enrolled via physician/hospital clinics and those recruited through online crowdsourcing. Through a nationwide crowdsource effort, we collected surveys from patients with history of IC/BPS. Study participants were asked to complete the validated instruments of Interstitial Cystitis Symptom Index (ICSI) and Interstitial Cystitis Problem Index (ICPI), as well as provide demographic information. We then compared the survey responses of patients recruited through crowdsourcing with those recruited from three specialized tertiary care urology clinics engaged in clinical research. Survey responses of 1300 participants were collected from all 50 states of the USA via crowdsourcing and 319 from a clinical setting. ICSI and ICPI were similar for IC/BPS patients diagnosed by the physicians in clinic and self-reported by subjects via crowdsourcing stating they have a history of previous physician diagnosis of IC/BPS. Surprisingly, ICSI and ICPI were significantly lower in crowdsourced control than in-clinic control subjects. The IP4IC Study provides valuable insights into the similarities and differences between patients recruited through clinics and those recruited through online crowdsourcing. There were no significant differences in disease symptoms among these groups. Individuals who express an interest in digital health research and self-identify as having been previously diagnosed by physicians with IC/BPS can be regarded as reliable candidates for crowdsourcing research.

Development of a patient-centered text message-based platform for the self-management of interstitial cystitis/bladder pain syndrome symptoms.

To develop a patient-centered text message-based platform that promotes self-management of symptoms of interstitial cystitis/bladder pain syndrome (IC/BPS). Adult women with IC/BPS interested in initiating a first- or second-line treatments per American Urological Association guidelines (recategorized as "behavioral/non-pharmacologic treatments" and "oral medicines" in the 2022 version) participated in rapid cycle innovation consisting of iterative cycles of contextual inquiry, prototype design and development. We delivered treatment modules and supportive messages using an algorithm-driven interactive messaging prototype through a HIPAA-compliant texting platform. Patients provided feedback through narrative text messages and an exit interview. Feedback was analyzed qualitatively and used to iteratively revise the platform until engagement ≥ 85% and accuracy ≥ 80% were achieved. The final version consisted of four treatment module categories (patient education and behavioral modification, cognitive behavioral therapy, pelvic floor physical therapy, and guided mindfulness practices) and supportive messages delivered through an automated algorithm over 6 weeks. Thirty IC/BPS patients with moderate symptom bother (median IC Problem Index score 9, range 6-12) participated in five cycles of contextual inquiry. Qualitative analysis identified three overarching concepts that informed the development of the platform: preference for patient centered terms, desire to gain self-efficacy in managing symptoms, and need for provider support. Patients preferred the term "interstitial cystitis" to "bladder pain syndrome" which carried the stigma of chronic pain. Patients reported greater self-efficacy in managing symptoms through improved access to mind-body and behavioral treatment modules that helped them to gain insight into their motivations and behaviors. The concept of provider support was informed by shared decision making (patients could choose preferred treatment modules) and reduced sense of isolation (weekly check in messages to check on symptom bother). A patient centered text message-based platform may be clinically useful in the self-management of IC/BPS symptoms.

Intravesical instillation of platelet-rich plasma for treatment of interstitial cystitis/bladder pain syndrome: A pilot study.

The aim of this study was to evaluate the feasibility of intravesical instillation of platelet-rich plasma (PRP) to treat interstitial cystitis/bladder pain syndrome (IC/BPS). Twenty PRP samples were tested in vitro for stability after exposure to urine samples with different pH. A pilot study involving 21 female patients with IC/BPS was conducted, and 6 weekly doses of autologous PRP (50 mL) were administered. Patients were followed up at the 2nd, 4th, 8th, and 12th weeks after terminating instillation. The primary endpoint was the visual analog scale (VAS) for pain, and the secondary endpoints included the IC symptom index, IC problem index of the O'Leary-Sant questionnaire and global response assessment, urine culture, and uroflowmetry. Success was defined as a reduction in VAS by 30% or more compared with basal level, and adverse events were recorded. The mean ± SD of VAS was significantly reduced compared with basal level (4.4 ± 2.6 vs. 8.8 ± 1.1, respectively, p = 0.001). Meanwhile, 80% of cases were considered successful, with a 50.1% reduction in the mean score compared with the basal level. The mean ± SD of IC symptom index and IC problem index significantly improved compared with the basal level. Global response assessment was markedly, moderately, and slightly improved in 2 (10%), 10 (50%), and 5 (25%) patients, respectively, and showed no change in 3 (15%). Three patients had positive urine cultures at follow-up, but 1 withdrew after 2 sessions because of a lack of efficacy. Repeated intravesical instillation of PRP could be considered an effective and safe approach for treating IC/BPS.

Comparative effectiveness and safety of cocktail therapy versus combined sodium hyaluronate and chondroitin sulphate (Ialuril): Intravesical instillation treatment of interstitial cystitis/bladder pain syndrome, which one to use?

Objective: To compare effectiveness and safety of intravesical therapy (sodium hyaluronate and chondroitin sulphate) Ialuril versus cocktail therapy for treatment of interstitial cystitis (IC). Materials and methods: Prospective study from March 2013 till August 2019 including all IC patients presented to our urology clinic. All IC patients underwent basic workup including urine test, urodynamic test and gynaecological/genital exam. Postoperatively, all patients received intravesical therapy. Patients were randomly allocated to either cocktail therapy (NaOH + heparin + lidocaine) or Ialuril (Sodium hyaluronate and chondroitin sulphate) therapy as intravesical seven cycles. The primary outcome was therapy effectiveness using Interstitial Cystitis Problem Index (ICPI) and Interstitial Cystitis Symptom Index (ICSI) improvement post therapy. Secondary outcome were for complications and compliance. Results: Total of 32 patients were included (6 males, 26 females) with mean age of 43 years (24–72 years), mean follow-up 36 months (15–72 months). Cocktail intravesical therapy was used in 21 patients while 11 patients received Ialuril. All patients showed improvement on their ICSI and ICPI scores post therapy from their baseline. Statistical analysis showed no significant difference between both groups regarding improvement in ICSI and ICPI index with p-value = 0.552 and p = 0.79, respectively. Infection and non-compliance is significantly high in the cocktail arm p = 0.004, p = 0.027 Conclusions: Intravesical cocktail therapy was equally effective as Ialuril in treating IC. Ialuril was preferred over cocktail therapy because of lower side effect; when considering ulcerative IC subgroup, we need large randomised controlled trials to compare therapy benefits.

Improved Urothelial Cell Proliferation, Cytoskeleton and Barrier Function Protein Expression in the Patients With Interstitial Cystitis/Bladder Pain Syndrome After Intravesical Platelet-Rich Plasma Injection.

PurposeTo investigate urothelial cell proliferation, cytoskeleton, inflammation, and barrier function protein expressions in patients with interstitial cystitis/bladder pain syndrome (IC/BPS) after intravesical platelet-rich plasma (PRP) injectionsMethodsA total of 19 patients with IC/BPS underwent 4 monthly intravesical PRP injections. Bladder biopsies were taken at the first and fourth PRP treatment. The bladder specimens were analyzed using the Western blot and immunochemical staining for progenitor cell markers for sonic hedgehog (Shh), CD34, and cytoskeleton proteins cytokeratin 5 (CK5), CK14, CK20; barrier function markers for zonula occludens-1 (ZO-1), E-cadherin, and intercellular adhesive molecule-1, tryptase and transforming growth factor-β (TGF-β). Global response assessment (GRA) was used to evaluate treatment outcomes.ResultsThe mean age of patients was 55.6 years. After PRP injections, the functional bladder capacity and maximum flow rate increased, and the visual analogue scale (VAS) of pain, interstitial cystitis (IC) symptom index, IC problem index, O’Leary-Sant symptom score, and GRA improved in all patients. Urothelium Shh, CK5, ZO-1, E-cadherin, and TGF-β expressions increased significantly after repeated PRP injections. By subgrouping, according to PRP treatment outcomes, significant increases in Shh, E-cadherin, and ZO-1 expressions were noted only in patients with GRA ≥1 or improved VAS, but not in patients with GRA=0 and no improvement in VAS.ConclusionsThe level of urothelial barrier function protein and cell proliferation protein expression in the patients with IC/BPS was increased after repeat intravesical PRP injections. Intravesical repeat PRP injections may have potential to improve urothelial health and result in symptoms improvement in the patients with IC/BPS.

The effect of intravesical cocktail therapy combined with low-dose amitriptyline on primary bladder pain syndrome

We compared the effectiveness of intravesical combination treatment and intravesical treatment plus low-dose amitriptyline in patients with primary bladder pain syndrome (PBPS). A total of 53 patients were included in the study. Demographic data, voiding frequency, nocturia, visual analog scale (VAS) scores, validated O'Leary-Sant IC Symptom Index (ICSI), and IC Problem Index (ICPI) scores and scores on the Short Form-36 (SF-36) questionnaire were collected from the patients at the beginning of the treatment, and at the 6th week and 6th month of the treatment. The patients were divided into two groups. Group 1 received intravesical treatment for 6 weeks. Group 2 received intravesical treatment plus amitriptyline at a dosage of 10mg/day. The frequencies of voiding and VAS scores were significantly improved in groups 1 and 2 at the 6th week compared with pretreatment (in group 1 p< 0.001, p< 0.001, and in group 2 p< 0.001, p< 0.001 respectively). The median ICSI and ICPI scores also significantly decreased in groups 1 and 2 (in group 1 p< 0.001, p< 0.001, and in group 2 p< 0.001, p< 0.001 respectively). Scores on the dimensions of the SF-36 questionnaire were significantly improved in both groups. There was no significant change in terms of VAS, nocturia, ICSI or ICPI scores when comparing the 6th week and 6th month results in groups 1 and 2 (all p> 0.05). Only role functioning/emotional achieved a significant improvement in group 2 (p =0.007). Intravesical combination therapies are effective in PBPS treatment. Adding low-dose amitriptyline to intravesical therapy in patients with PBPS improves emotional status.

Efficacy of intravesical cocktail therapy with or without dimethyl sulphoxide in interstitial cystitis.

Interstitial cystitis (IC) is a chronic bladder inflammation with unknown etiologies that impairs the quality of life of patients. We aimed to investigate the efficacy of dimethyl sulphoxide (DMSO) use in the cocktail therapy in IC patients. Patients treated with intravesical cocktail therapy which contained a mixture of 10 mL of bupivacaine, 1 mL of heparin, and 9 mL of sodium bicarbonate, was introduced to Group 1, and, 25 mL of DMSO was added to this cocktail and introduced to Group 2. Statistical analyses between groups were assessed by Turkish validated O'Leary Sant score composed of IC Symptom Index (ICSI) and IC Problem Index (ICPI), visual analog scale (VAS) score, and short form-36 (SF-36) questionnaire in the baseline versus post-instillation week 6, month 6, and month 12, comparatively. A total of 62 patients (58 women and 4 men) with a median age of 52 (28-76) years were included. Baseline versus post-instillation 6th week of ICSI and ICPI scores were 15 ±3.4 vs 7.4 ±2.9 and 12.6 ±2.8 vs 6.1 ±2.7, respectively (p <0.001 and <0.001, respectively). VAS scores of Group 2 were statistically significantly lower than that of Group 1 in the post-instillation month 6 (p = 0.03) whereas, the baseline of VAS scores were similar. Intravesical cocktail therapy is an effective and reliable treatment method and can be safely applied with or without DMSO. Adding DMSO to cocktail therapy provides a further decrease in VAS score in the post-instillation month 6.

Evidence for Early Cyclosporine Treatment for Hunner Lesion Interstitial Cystitis.

The objective of this study was to evaluate our experience using cyclosporine A (CyA) in the treatment of Hunner lesion interstitial cystitis (HLIC). Retrospective chart review was performed on patients with HLIC treated with CyA from August 2012 to September 2019. Demographic and clinical variables, number of interstitial cystitis therapies, frequency, nocturia, and bladder pain visual analog scores before and after CyA treatment were collected, as well as the Global Response Assessment (GRA) and the Interstitial Cystitis Symptom Index and Interstitial Cystitis Problem Index. CyA responders were defined as those with moderately or markedly improved GRA scores. A total of 51 patients with HLIC treated with CyA were identified. Mean follow-up was 3 years (0.36-6.8 years). Seventy-six percent (28 of 37) were female; mean age was 68 years (51-84 years). Before CyA treatment, an average of 8 previous therapies were tried and patients reported an average of 8 of 10 bladder pain. Daytime frequency was 11-20 times per day, and nocturia was 7 times per night. Per the GRA, 84% (31 of 37) were considered CyA responders. Posttherapy Interstitial Cystitis Symptom Index and Interstitial Cystitis Problem Index scores were lower in responders compared with nonresponders (8.9 ± 5.7 vs 21.3 ± 7.0, P = 0.001). Bladder pain, number of hydrodistentions/fulgurations, nocturia, and daytime frequency improved significantly after CyA treatment. The cyclosporine A response rate was 84%, with most of these patients reporting marked improvement. Bladder pain, daytime frequency, and nocturia were significantly improved after CyA treatment, and the number of interventions after CyA treatment decreased. Cyclosporine A should be considered earlier than fifth-line therapy in HLIC.

Assessment of Treatment Outcomes of Interstitial Cystitis with Sodium Hyaluronate by The O’leary-Sant Interstitial Cystitis Symptom Index (ICSI) and Interstitial Cystitis Problem Index (ICPI))

Objective: To assess the treatment outcome of interstitial cystitis with sodium hyaluronate (cystistat) installation by O’Leary-Sant interstitial cystitis symptom index (ICSI) and interstitial cystitis problem index (ICPI).Material and methods: From January 2019 to October 2020, 11 patients diagnosed with interstitial cystitis were treated with sodium hyaluronate (cystistat) installation. Each patient was assessed using the O’Leary-Sant interstitial cystitis symptom index (ICSI) and interstitial cystitis problem index (ICPI) before and after therapy.Results: The number of interstitial cystitis patients who completed the installation program in this study was 11 patients. In the assessment of interstitial cystitis symptom index (ICSI), there was a significant clinical improvement in each of the symptoms, which are urgency, frequency, nocturia, and bladder pain, with statistical test results obtained p-value (0.002, 0.003, 0.003, and 0.003) consecutively. In the interstitial cystitis problem index (ICPI) study, clinical improvements were obtained from each symptom in the form of urgency, frequency, nocturia, and bladder pain with statistical test results obtained p-value (0.002, 0.003, 0.003, and 0.003) consecutively.Conclusion: In all interstitial cystitis patients who were treated with sodium hyaluronate installation in this study, there was a significant difference in the values of O’Leary-Sant interstitial cystitis symptom index (ICSI) and interstitial cystitis problem index (ICPI) before and after therapy. This shows that sodium hyaluronate (cystistat) installation therapy is very effective for interstitial cystitis patients.

Effect of focal and diffuse hypervascularization as cystoscopic findings on predicting intravesical therapy response in patients with bladder pain syndrome.

To define the relationship between cystoscopic findings, including novel findings such as the hypervascularization, of bladder pain syndrome/interstitial cystitis (BPS/IC) and the response to intravesical therapy. We retrospectively evaluated cystoscopy findings in patients who had a preliminary diagnosis of BPS/IC. All patients received early intravesical combined therapy (ICT), ie, within 2 hours after hydrodistention. Additionally, ICT was continued according to our protocol. Cystoscopic findings were classified as glomerulations, hypervascularization, and Hunner's lesion (HL). The therapy responses were evaluated at 1st, 3rd, 6th, and 12thmonths using the visual analog scale (VAS), O'Leary/Sant interstitial cystitis symptom index (ICSI), and interstitial cystitis problem index (ICPI) scores. Out of 61 patients, HL was diagnosed during cystoscopy in six (9.8%) patients, glomerulations in 35 (57.4%) patients, and hypervascularization in 15 (24.6%) patients. No pathological findings were defined in five (8.2%) patients. In the glomerulation and hypervascularization group, the median VAS, ICSI, and ICPI scores were lower than those in the preoperative period in the follow-up. In patients with HL, the median VAS scores were lower in the entire follow-up compared to the preoperative period, with an increase at 1st year compared to 6th month, and ICSI scores were lower than preoperative period in the entire follow-up, with an increase at 3rd month and 1st year. ICPI scores were also lower during the follow-up, with an increase observed in the 1st year. The presence of hypervascularization should be defined since it might show different characteristics that may affect the ICT response. Patients with glomerulations might be good candidates for early combined intravesical therapy.

Efficacy and safety comparison of pharmacotherapies for interstitial cystitis and bladder pain syndrome: a systematic review and Bayesian network meta-analysis.

The objective was to compare the clinical efficacy and safety of pharmacological interventions for interstitial cystitis and bladder pain syndrome (IC/BPS) with direct and indirect evidence from randomized trials. We searched PubMed, the Cochrane library, and EMBASE for randomized controlled trials (RCTs) that assessed the pharmacological therapies for IC/BPS. Primary efficacy outcomes included ICSI (O'Leary Sant Interstitial Cystitis Symptom Index), ICPI (O'Leary Sant Interstitial Cystitis Problem Index), 24-h micturition frequency, visual analog scale (VAS), and Likert score for pain. Safety outcomes are total adverse events (AEs, intravesical instillation, and others), gastrointestinal symptoms, headache, pain, and urinary symptoms. A systematic review and Bayesian network meta-analysis were performed. A total of 23 RCTs with 1,871 participants were identified. The ICSI was significantly reduced in the amitriptyline group (MD = -4.9, 95% CI: -9.0 to -0.76), the cyclosporine A group (MD = -7.9, 95% CI: -13.0 to -3.0) and the certolizumab pegol group (MD = -3.6, 95% CI:-6.5 to -0.63) compared with placebo group. Moreover, for ICPI, cyclosporine A showed superior benefit compared to placebo (MD = -7.6, 95% CI: -13 to -2.3). VAS score improved significantly in cyclosporine A group than pentosan polysulfate sodium (MD = 3.09, 95% CI: 0.13 to 6.07). None of the agents revealed a significant alleviation of 24-h micturition frequency. In terms of safety outcomes, the incidence rate on urinary symptoms for botulinum toxin A was the only variate higher than chondroitin sulfate (MD = -2.02, 95% CI: -4.99 to 0.66) and placebo (MD = -1.60, 95% CI:-3.83 to 0.17). No significant difference was found among the other treatments. Cyclosporine A might be superior to other pharmacological treatments in efficacy. Amitriptyline and certolizumab pegol were capable of lowering the ICSI as well.