Interstitial Cystitis Symptom Index Score Research Articles

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.

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.

Efficacy of Pentosan Polysulfate Treatment in Patients with Interstitial Cystitis/Bladder Pain Syndrome.

Pentosan Polysulfate (PPS) is the only oral treatment for interstitial cystitis (IC)-bladder pain syndrome (BPS) approved by the World Health Organization. Self-evaluation scales can provide more objective results on pre- and post-treatment satisfaction. The aim of this study was to investigate the effect of pentosan polysulfate treatment on symptoms in IC-BPS patients. This study included 37 adult male and female patients with IC-BPS who reported pain, urinary urgency, polyurea, and nocturia without urinary tract infection for a minimum of six months prior to the study and were taking 300 mg/day oral pentosan polysulfate. Pre- and post-treatment symptoms, Interstitial Cystitis Symptom Index (ICSI) Scores, quality of life (QoL) scores (1-4), and satisfaction conditions were examined. Following the application of inclusion and exclusion criteria, mean age of 37 suitable patients was 46.0±11.9 years and 27% (10 individuals) of the patients were male. Pre-treatment, ICSI scores, and measures of satisfaction degree and QoL increased significantly after the treatment (p<0.001). Adverse reaction was detected in two patients (5.4%) among the patients treated with pentosan polysulfate. Oral pentosan polysulfate for the treatment of interstitial cystitis/bladder pain syndrome treatment could achieve recovery in symptoms, increase Interstitial Cystitis Symptom Index score and improve quality of life and patient satisfaction.

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 ...

Efficacy of transcutaneous tibial nerve stimulation in the treatment of bladder pain syndrome.

This study aimed to demonstrate the effectiveness of transcutaneos tibial nerve stimulation (TTNS) in the treatment of bladder pain syndrome (BPS). The data of 16 female patients, diagnosed with BPS in our clinic between 2019 and 2021 and had TTNS twice a week for 12 weeks, were retrospectively analyzed. The mean age of the patients was 46.00 ± 13.11 years, and the mean body mass index was 26.43 ± 3.07 kg/m2. After the treatment, the median day time frequency of the patients decreased from 13.37 (3.69) to 10.25 (4.56) (p < 0.001). Nocturia also decreased after treatment from 4.37 (1.81) to 3.00 (1.94) (p = 0.001). The median voiding volume increased by 26.5 mL (p = 0.001). The median of the patients' visual analog scale scores decreased after treatment (median of visual analog scale score changed from interquartile range 8 [1] to 7 [4]) (p = 0.001). In addition, the median interquartile range interstitial cystitis symptom index scores decreased from 17 (4) to 15 (10) (p = 0.002). In this study it was demonstrated that TTNS is an alternative method that can be successfully applied before invasive methods in the treatment of 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.

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.

The diagnostic and therapeutic efficacy of cystoscopy with hydrodistension and random biopsies in clinically suspected interstitial cystitis/bladder pain syndrome

ObjectiveWe aimed to explore the diagnostic and therapeutic efficacy of cystoscopy with hydrodistension and random biopsies for clinically suspected interstitial cystitis/bladder pain syndrome (IC/BPS). Study designWe reviewed the data of fifty-five clinically suspected IC/BPS patients underwent cystoscopy with hydrodistension and random biopsies. Global Response Assessment was used to evaluate the efficacy. Disease severity was assessed by thorough history, physical examination, 3-day frequency volume chart, visual analog scale of pain, Interstitial Cystitis Symptom Index (ICSI) and clinical phenotype system (UPOINT). ResultsAccording to the pathologic outcomes from random biopsies, three out of the 55 clinically suspected IC/BPS were diagnosed as bladder carcinoma. Among the 52 IC/BPS patients, thirty-six patients (69.2%) had initial chief complaints of urinary frequency and urgency. Under cystoscopy, twenty-nine patients and 23 patients were classified as Hunner ulcer type and diffuse global mucosal bleeding (grade III glomerulation). The median functional bladder capacity of the 52 IC/BPS patients was 100 ml. Hydrodistension was effective in 28 patients (53.8%) at postoperative 3 months, which decreased to 25% at post-hydrodistension 6 months and to 13.5% at 12 months. For the 28 hydrodistension-effective patients, the remission degrees of daytime frequency, nocturia, VAS bladder pain and ICSI score were 50.3%, 49.4%, 68.1% and 48%, which were significantly higher than the 16.9% (daytime frequency, P < 0.001), 20.5% (nocturia, P = 0.021), 7.4% (VAS pain score, P < 0.001) and 6.1% (ICSI, P < 0.001) in the hydrodistension-negative group. According to the UPOINT system, the hydrodistension-effective cases had significantly higher rates of symptom remission in U (P = 0.002), P (P = 0.026), O (P < 0.001), and T (P < 0.001) domains than the corresponding negative cases. In effective group, the O domain had the most remission rate (26 out of 28, 92.9%, P < 0.001), followed by the U domain (12 out of 28, 42.9%, P < 0.001) and T domain (12 out of 28, 42.9%, P < 0.001). ConclusionHistopathological analysis from random biopsies could distinguish bladder carcinoma from clinically suspected IC/BPS. Hydrodistension is more likely to be effective when chronic pelvic pain is obviously alleviated. The efficacy of hydrodistension could act in a certain period of time.

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.

Cystoscopic findings in women with minimal and maximal lower urinary tract symptoms.

BackgroundGlomerulations are not specific for interstitial cystitis/bladder pain syndrome (IC/BPS). Controversy exists about whether cystoscopic findings differ between patients with and without lower urinary tract symptoms. We sought to compare the prevalence of cystoscopic findings in women with “no or minimal” urinary symptoms to those with a “high” symptom burden.MethodsThis is a secondary analysis of a prospective cohort study performed at a University Educational Facility. Participants in this study were part of a larger prospective study, in which female patients scheduled to undergo routine gynecologic procedures were all consented for cystoscopy with hydrodistension (CWHD). We defined the “minimally symptomatic group” as those with ≤1 on each of the O’Leary/Sant Interstitial Cystitis Symptom Index (ICSI) subscores and without history of IC/BPS. The “highly symptomatic” cohort of women had composite ICSI score ≥12 and a Burning/Pain subscore of 4 or 5. All were non-smokers.ResultsA total of 84 women underwent CWHD, with 33 having minimal symptoms and 51 being highly symptomatic. The two groups were not statistically different when assessing for ‘any glomerulations’ compared to ‘no glomerulations.’ However, minimally symptomatic women had an eight-fold lower prevalence of significant glomerulations than highly symptomatic women (3.0% minimally symptomatic vs. 23.5% highly symptomatic, P<0.05.)ConclusionsExtensive glomerulations (≥10 in 3 or 4 quadrants) are rare in women with minimal urinary symptoms. These findings contrast with prior limited prospective data which quoted similar incidence of glomerulations in IC/BPS patients and asymptomatic patients. This study highlights the importance of evaluating objective evidence on CWHD and merits further investigation as part of the ongoing conversation regarding the definition of bladder health and pathology

Efficacy and safety of intravesical instillation of KRP-116D (50% dimethyl sulfoxide solution) for interstitial cystitis/bladder pain syndrome in Japanese patients: A multicenter, randomized, double-blind, placebo-controlled, clinical study.

ObjectiveTo evaluate the efficacy and safety of intravesical KRP‐116D, 50% dimethyl sulfoxide solution compared with placebo, in interstitial cystitis/bladder pain syndrome patients.MethodsJapanese interstitial cystitis/bladder pain syndrome patients with an O’Leary‐Sant Interstitial Cystitis Symptom Index score of ≥9, who exhibited the bladder‐centric phenotype of interstitial cystitis/bladder pain syndrome diagnosed by cystoscopy and bladder‐derived pain, were enrolled. Patients were allocated to receive either KRP‐116D (n = 49) or placebo (n = 47). The study drug was intravesically administered every 2 weeks for 12 weeks.ResultsFor the primary endpoint, the change in the mean O’Leary‐Sant Interstitial Cystitis Symptom Index score from baseline to week 12 was −5.2 in the KRP‐116D group and −3.4 in the placebo group. The estimated difference between the KRP‐116D and placebo groups was −1.8 (95% confidence interval −3.3, −0.3; P = 0.0188). Statistically significant improvements for KRP‐116D were also observed in the secondary endpoints including O’Leary‐Sant Interstitial Cystitis Problem Index score, micturition episodes/24 h, voided volume/micturition, maximum voided volume/micturition, numerical rating scale score for bladder pain, and global response assessment score. The adverse drug reactions were mild to moderate, and manageable.ConclusionsThis first randomized, double‐blind, placebo‐controlled trial shows that KRP‐116D improves symptoms, voiding parameters, and global response assessment, compared with placebo, and has a well‐tolerated safety profile in interstitial cystitis/bladder pain syndrome patients with the bladder‐centric phenotype.

First-line treatment posterior tibial nerve stimulation in patients with interstitial cystitis/bladder pain syndrome.

IntroductionThe aim of this study was to determine the effects of first-line treatment posterior tibial nerve stimulation (PTNS), applied once a week for a 12 week period, as a treatment modality for patients with Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS).Material and methodsA total of 39 female patients with IC/BPS were enrolled in the study. Patients had one 30-minute session of PTNS per week for 12 weeks and symptoms were assessed before and after the treatment sessions by the use of a voiding diary, visual analog scale (VAS) for pain, O'Leary-Sant interstitial cystitis symptom index (ICSI), and O'Leary-Sant interstitial cystitis problem index (ICPI).ResultsThe mean age of the patients was 38.9 ±7.1 years. The improvements in voiding diary parameters after 12 weeks of PTNS treatment were statistically significant compared to baseline but the changes in nocturia, and average voiding volume were not statistically significant. Mean parametric improvements after 12 weeks of PTNS treatment compared to baseline included a daytime frequency decrease by 3.8 voids daily, urgency episodes decrease by 4.7 episodes daily, nocturia decrease by 0.3 voids and voided volume improvement by a mean of 8.4 ml. The difference for ICSI, ICPI and VAS between baseline and the 12th week of PTNS treatment scores demonstrated statistically significant improvements in pain severity, symptom and problem index.ConclusionsThe findings in this study demonstrated the improvements of voiding diaries, ICSI, ICPI and VAS scores in patients with IC/BPS after 12 weeks PTNS. PTNS treatment is a beneficial firs-line treatment option to IC/BPS symptom amelioration.

Reliability and validity of Turkish versions of the interstitial cystitis symptom index and interstitial cystitis problem index.

To validate the Turkish versions of the interstitial cystitis symptom index (ICSI) and interstitial cystitis problem index (ICPI) for use in Turkish speaking patients with bladder pain syndrome/interstitial cystitis (BPS/IC). After translation of the original ICSI and ICPI into the Turkish language, Turkish versions of ICSI and ICPI were self-administered to all participants. Test-retest reliability (intraclass correlation coefficient) was evaluated at 2 weeks intervals in the BPS/IC group. Internal consistency was evaluated using Cronbach's alpha. Scores of ICSI and ICPI was compared between BPS/IC and control groups to examine discriminant validity. Criterion validity was examined via investigating the correlations between bladder diary data (24-hour frequency and nocturia), visual analogue scale (VAS) scores, and results to the corresponding questions in ICSI and ICPI. Results of 79 patients with BPS/IC and 50 control patients were analyzed. Both indices showed high internal consistency (Cronbach's α for ICSI and ICPI was 0.879 and 0.923, respectively). The test-retest reliability of ICSI and ICPI was high for total scores and subdomains of both indices (intraclass correlation coefficient was 0.722 for ICSI and 0.777 for ICPI). Scores of both indices were significantly higher in BPS/IC group than the control group (P < .001). Statistically significant correlations were found between 24-hour frequency, nocturia, VAS scores, and corresponding questions in the indices. A statistically significant and strong correlation was observed between ICSI and ICPI scores (P < .001, rS = .632). Turkish versions of ICSI and ICPI are reliable, consistent, and valid instruments to evaluate symptoms of Turkish speaking patients with BPS/IC.

Changes in uroplakin expression in the urothelium of patients with ulcerative interstitial cystitis/bladder pain syndrome.

PurposeWe evaluated changes in the expression of uroplakin (UP) in the urothelium of patients with ulcerative interstitial cystitis/bladder pain syndrome (IC/BPS).Materials and MethodsBladder samples were collected from 19 patients with ulcerative IC/BPS who were treated with augmentation ileocystoplasty and from 5 control patients. Frequency-volume charts, the pain visual analogue scale (VAS), and the O'Leary-Sant interstitial cystitis symptom index (ICSI) and problem index (ICPI) were used to evaluate the patients' symptoms preoperatively. The expression levels of UP-Ib and UP-III in the urothelium were compared between the IC/BPS patients and control patients.ResultsSixteen women and three men with IC/BPS were evaluated. Their values for preoperative mean voiding frequency, number of nocturia episodes, and functional bladder capacity as recorded in frequency-volume charts were 21.1±12.8, 5.9±4.2, and 151.1±62.7 mL, respectively. The mean pain VAS, ICSI, and ICPI scores were 8.4±1.3, 17.7±2.2, and 14.7±1.8, respectively. Immunofluorescence staining showed that UP-Ib and UP-III were localized in the urothelium. Upon Western blot analysis, the expression of UP-III was significantly increased in the IC/BPS group compared with the control group. However, expression of UP-Ib did not differ significantly between the IC/BPS and control groups.ConclusionsUP-III was significantly upregulated in patients with ulcerative IC/BPS. UP-III is a potential biomarker for the diagnosis of ulcerative IC/BPS.

Outcomes of intravesical chondroitin-sulfate and combined hyaluronic-acid/chondroitin-sulfate therapy on female sexual function in bladder pain syndrome.

Our aim was to determine the efficacy of intravesical chondroitin sulfate (CS) and combined hyaluronic acid/chondroitin sufate (HA/CS) treatment and their effects on sexual function of females with interstitial cystitis/bladder pain syndrome (IC/BPS). A total of 68 female patients with IC/BPS between 2012 and 2018 were reviewed. Thirty-three patients were treated with combined HA/CS and 28 patients were treated with CS. Instillations were performed weekly for the first month, biweekly for the second month, and monthly in the third and fourth months. Before and after the sixth month of the treatment, all patients were evaluated with the Female Sexual Function Index (FSFI), visual analog pain scale (VAS), interstitial cystitis symptom index (ICSI), interstitial cystitis problem index (ICPI), and voiding diary, and changes were recorded. A statistically significant improvement was determined for FSFI, VAS, ICSI, and ICPI scores after treatment in both groups. Among baseline characteristics, a weak but significant negative correlation was determined only between the ICSI score improvement and age (rho: -0.38; p = 0.03) on statistical analysis. Compared with CS, combined HA/CS treatment was superior in terms of ICSI, ICPI, and daytime and nighttime frequency improvement (0.042, 0.038, 0.039, and 0.045; respectively). All domains of the sexual function index were significantly improved at the sixth month of intravesical therapy in both groups. A statistical difference was not found between the two groups. Although it seems that intravesical HA/CS combination is superior to CS alone in terms of symptom reduction, both of them have beneficial effects on sexual function.

Does repeated hydrodistension with transurethral fulguration for interstitial cystitis with Hunner’s lesion cause bladder contraction?

ABSTRACTObjective: To evaluate the effect of repeated bladder hydrodistension with transurethral resection or fulguration (TUF) of Hunner’s lesions on bladder capacity and interstitial cystitis (IC) symptoms. TUF for Hunner’s lesion is recommended in several IC/BPS guidelines, although recurrence is highly probable.Patients and methods: The study cohort comprised 44 IC patients with Hunner’s lesions who underwent multiple bladder hydrodistensions with TUF and electrocautery (EC) at our institution between July 2005 and June 2018. We analysed their frequency–volume chart, O’Leary Sant Interstitial Cystitis Symptom Index (ICSI), Interstitial Cystitis Problem Index (ICPI), and visual analogue scale (VAS) for pain, before and at 2, 6, and 12 months after surgery.Results: The 44 Hunner-type IC patients underwent a total of 117 surgeries. Patients were divided into three groups based upon the number of hydrodistensions with TUF they underwent. Group 1 (n = 44), Group 2 (n = 44) and Group 3 (n = 21) underwent one, two, and three surgeries, respectively. At 6 months after surgery, the mean average voided volume (AVV) and maximum voided volume (MVV) were 157 mL and 228 mL in Group 1; 203 mL, 283 mL in Group 2; and 193 mL, 264 mL in Group 3. The AVV in Group 2 (P < 0.01) and Group 3 (P < 0.03), and the MVV in Group 2 (P < 0.02) increased significantly compared to Group 1. ICSI, ICPI and VAS pain score in groups 2 (P < 0.003, P < 0.01, P < 0.05) and 3 (P < 0.001, P < 0.001, P < 0.001) decreased significantly compared to Group 1.Conclusion: Repeated hydrodistension and TUF with EC of Hunner’s lesions for recurrent Hunner-type IC patients improved their symptoms. There was a tendency toward an increase in bladder capacity and repeated hydrodistension with TUF did not appear to be a direct cause of bladder contraction.Abbreviations: AVV: average voided volume; BPS: bladder pain syndrome; EC: electrical cautery; IC: interstitial cystitis; ICPI: Interstitial Cystitis Problem Index; ICSI: Interstitial Cystitis Symptom Index; MVV: maximum voided volume; TUF: transurethral fulguration; TUR: transurethral resection; VAS: visual analogue scale

A genome-scale DNA methylation study in women with interstitial cystitis/bladder pain syndrome.

To assess the feasibility of using voided urine samples to perform a DNA methylation study in females with interstitial cystitis/bladder pain syndrome (IC/BPS) as compared to age- and race-matched controls. A unique methylation profile could lead to a non-invasive, reproducible, and objective biomarker that would aid clinicians in the diagnosis of IC/BPS. Nineteen IC/BPS patients and 17 controls were included. IC/BPS patients had an Interstitial Cystitis Symptom Index score of >8; controls had no bladder symptoms. DNA was extracted from pelleted urine sediment. Samples with >500 ng of genomic DNA underwent quantitative DNA methylation assessment using the Illumina Infinium MethylationEPIC BeadChip. Age- and race-matching was applied prior to analysis. Linear regression models were used to compare average methylation between IC/BPS cases and controls at each cytosine guanine dinucleotide site (loci where methylation can occur). Sixteen participants (eight IC/BPS age- and race-matched to eight controls) had adequate DNA for methylation analysis. The median age was 43.5 years (interquartile range 33.8, 65.0), the median BMI was 27.1 (IQR 22.7, 31.4), and 14 were Caucasian (87.5%). A total of 688 417 CpG sites were analyzed. In exploratory pathway analysis utilizing the top 1000 differentially methylated CpG sites, the mitogen-activated protein kinase (MAPK) pathway was overrepresented by member genes. The results demonstrate the feasibility of using voided urine specimens from women with IC/BPS to perform DNA methylation assessments. Additionally, the data suggest genes within or downstream of the MAPK pathway exhibit altered methylation in IC/BPS.

Safety and Feasibility of Intravesical Instillation of Botulinum Toxin-A in Hydrogel-based Slow-release Delivery System in Patients With Interstitial Cystitis-Bladder Pain Syndrome: A Pilot Study

To assess the feasibility and the safety of a mixture instillation of TC-3 gel, a novel reverse-thermal gelation hydrogel, and botulinum toxin-A (BTX-A) for the treatment of interstitial cystitis-bladder pain syndrome (IC/BPS). TC-3 gel-BTX-A mix is instilled into the bladder as liquid, solidifies because of body heat, and gradually dissolves to release BTX-A for several hours. A single intravesical instillation of 200 U BTX-A premixed with 40 mL TC-3 gel was delivered to the bladder. Adverse events and preliminary efficacy outcome measures were assessed: bladder diary, visual analog scale (VAS) for pain, and Interstitial Cystitis Symptom Index (ICSI) and Interstitial Cystitis Problem Index (ICPI) at baseline and at 2, 6, and 12 weeks. A total of 15 severely symptomatic patients with IC/BPS (ICSI and ICPI score ranges 12-19 and 12-16, respectively; median VAS = 7) were enrolled (male and female = 4 and 11, ages 24-76). In terms of safety, no increase in VAS score was noted at instillation. All adverse events were transient and mild, the most common being temporary mild constipation (n = 4, 26%). The mean VAS at baseline vs week 12 was 6.6 ± 2.7 vs 5.3 ± 2.8 (P = .044). The mean ICSI and ICPI scores were reduced at week 12 compared with baseline (15.4 ± 2.4 vs 12.9 ± 4.3, P = .004, and 14.8 ± 1.4 vs 11.9 ± 4.0, P = .004, respectively). The mean number of voids per night at baseline decreased for 6 weeks (3.3 ± 2.1 vs 1.8 ± 0.9, P = .046) and then returned to baseline level at week 12. Intravesical instillation of a TC-3 gel-BTX-A mixture is safe and tolerable. Preliminary results suggest temporary efficacy lasting for a few weeks.

Efficacy, Side Effects, and Monitoring of Oral Cyclosporine in Interstitial Cystitis-Bladder Pain Syndrome

To evaluate the efficacy of oral cyclosporine A (CyA) in the treatment of refractory interstitial cystitis-bladder pain syndrome (IC-BPS) and to assess safety using drug level and renal function monitoring. Patients with IC-BPS who failed at least 2 prior treatments were enrolled in an open-label study of oral CyA. Medication was started at 3 mg/kg divided twice daily for 3 months. Dose was adjusted based on side effects and the drug level was measured 2 hours after the morning dose (C2). The primary end point was moderate or marked improvement of global response assessment or >50% improvement on the Interstitial Cystitis Symptom Index (ICSI) or Interstitial Cystitis Problem Index at 3 months. Twenty-two of 26 patients completed the 3-month follow-up; 18 completed the poststudy evaluation. The median symptom duration was 66 months (12-336). At 3 months, 31% (8/26) improved by global response assessment, 15% (4/26) had >50% improvement in the ICSI score, and 19% (5/26) had an improvement in the Interstitial Cystitis Problem Index score. Hunner lesions (HLs) predicted an improvement in the ICSI score (odds ratio = 15.4, 95% confidence interval: 1.7-224.6, P = .01), with 75% (3/4) of the responders having HL. Two patients withdrew because of hypertension or elevated serum glucose. The mean nuclear glomerular filtration rate declined at 3 months (98.9 ± 31.6 vs 84.2 ± 25.5 mL/min/1.73 m2, P = .01) and reversed to baseline after discontinuation of treatment. C2 levels did not correlate with symptoms but allowed dose reduction in 11 patients. Per American Urological Association guidelines, CyA can be effective in a proportion of patients with refractory IC-BPS. Patients with HL are more likely to benefit. Monitoring of C2 rather than trough levels can lead to dose reduction, thereby minimizing toxicity.

Complete response to acupuncture therapy in female patients with refractory interstitial cystitis/bladder pain syndrome.

Interstitial Cystitis/Bladder Pain syndrome (IC/BPS) is a considerable issue in urology and gynecology and unfortunately, the treatment options recommended are not fully efficient. Therefore, in this study we aimed to determine the effectiveness of acupuncture treatment in patients with refractory IC/BPS. 12 refractory IC/BPS female patients received ten sessions of acupuncture twice a week. The visual analog score (VAS), interstitial cystitis symptom index (ICSI), interstitial cystitis problem index (ICPI), O'Leary-Saint symptom score (OSS), Patient Health Questionnaire (PHQ9), Pelvic pain and urgency & frequency patient symptom scale tests (PUF) and maximum voided volume (MVV) was completed in 1st, 3rd, 6th and 12th months following the treatment. There was a statistically significant decrease in all of the scores evaluated at first month compared with the baseline. While the change in VAS score in 1, 3, 6 and 12th months were found statistically significant, measurements of ICSI, OSS and PUF scores and MVV values in the 6th and 12th months and ICPI and PHQ scores in the 12th month were not found statistically significant compared to the pre-treatment period. Response to treatment for the first three months after acupuncture application was (100%), but this ratio was measured as 33.3% (4/12) in the sixth month and 16.6% in the 12th month (2/12). The results of this study suggest that acupuncture appears to be an effective, useful, non-invasive method in IC/BPS patients. It can be used as an appropriate treatment method not only in refractory but also in IC patients since it is rather advantageous compared to other treating agents.