Interstitial Cystitis Symptom Index Research Articles

Comparison of algorithms in the latest clinical practice guidelines for female incontinence between Taiwan urological association and others

s / Urological Science 26 (2015) S50eS81 S78 (IPSS), Overactive Bladder Symptom Score (OABSS), O'leary-Sant Interstitial Cystitis Symptom Index (ICSI) and Problem Index (ICPI). Treatment efficacy was assessed by comparing the preand post-treatment mean scores of the five questionnaires using paired t test. Results: The mean age of the patients was 22.4. The mean duration of ketamine abuse was 57± 20 months. After intravesical HA therapy for 4 weeks, statistically significant mean decreases in VAS (from 7 to 4.4, p 1⁄4 0.03), IPSS voiding subscore (from 16.2 to 11.6, p 1⁄4 0.017) and ICSI (from 16.4 to 13.6; p 1⁄4 0.016) questionnaire scores were seen. However, only ICSI constantly reduced after 4 weeks of treatment. Conclusion: Intravesical HA therapy may have sort-term benefit for improving bladder pain and voiding symptoms in patients with KC. Intravesical instillation of HA on a monthly basis may not be as effective as on a weekly basis. NDP107: COMPARISON OF ALGORITHMS IN THE LATEST CLINICAL PRACTICE GUIDELINES FOR FEMALE INCONTINENCE BETWEEN TAIWAN UROLOGICAL ASSOCIATION AND OTHERS Chih-Cheng Lu, Wen-Chou Fan, Tse-Chou Cheng. Division of Urology, Department of Surgery, Chi Mei Medical Center, Liouying, Tainan Purpose: This study is to compare the clinical practice guidelines (CPGs) in managing female incontinence between Taiwan and others in the world. We focused on the algorithms and non-surgical management for female incontinence. Materials and Methods: The printed and online materials in medical guidelines or consensus for female incontinence by Taiwan Urological Association (TUA) and others were reviewed. Several statements were compared including published date, revision history, patient selection, diagnostic methods, and especially the non-surgical management. Results: In addition to the CPG by TUA, the American College of Physicians (ACP) and reviews from British Medical Journal (BMJ) were collected. The first and latest edition of CPG for female lower urinary tract symptoms (LUTS) by TUA was published in August 2014. The CPG by ACP and reviews from BMJ were published in September 2014. For stress incontinence but not urgent incontinence, pelvic-floor muscle training was recommended as first-line treatment in ACP, but not clearly recommended by TUA. Reducing body mass index below 25 was suggested by BMJ. Reduction of more than 5 percent of weight was suggested in obese diabetic women by TUA. Caring for constipation is mentioned for life modification by ACP and BMJ but no by TUA. At least four weeks of pharmacological treatment was mentioned in BMJ, but not clearly mentioned in ACP and TUA. Conclusion: In this timely evaluation, variation exists between TUA and others in the CPGs for female incontinence. Several points are suggested to be revised in Taiwanese CPG by TUA. It is warranted to confirm these findings by further investigation.

The effects of intravesical therapy with hyaluronic acid for painful bladder syndrome: Preliminary Chinese experience and systematic review

ObjectiveTo present the preliminary results of treating a series of Chinese patients with painful bladder syndrome/interstitial cystitis (PBS/IC) using intravesical hyaluronic acid (HA). Materials and methodsA series of 13 patients with PBS/IC received first-line therapy followed by HA once-a-week for 4 weeks and then once monthly for 4 months. Outcomes measured included O'Leary-Sant Interstitial Cystitis Symptom Index (ICSI) and Interstitial Cystitis Problem Index (ISPI) scores, voiding frequency, and bladder capacity. ResultsISPI and ICSI scores were significantly (p < 0.001) decreased after treatment [median change (interquartile range): ISPI = 2 (2–3); ICSI = 3 (2–3)]. Voiding frequency and functional bladder capacity were significantly (p < 0.001) decreased [median change: 7 (6–8) times/d] and increased [median change: 190 (116–233) mL], respectively after treatment. ConclusionOur case series supports the efficacy of intravesical HA in the treatment of PBS/IC.

Anesthetic Bladder Hydrodistention Is Superior to Superior Hypogastric Plexus Neurolysis in Treatment of Interstitial Cystitis–bladder Pain Syndrome: A Prospective Randomized Trial

To evaluate efficacy and safety of superior hypogastric plexus neurolysis (SHN) for treatment of interstitial cystitis (IC)-bladder pain syndrome (BPS) in comparison with bladder hydrodistention (HD). In a prospective study, 24 female patients were randomly allocated to receive either SHN or HD. Patients were evaluated by recording the O'Leary-Sant IC symptom indices, IC problem indices, pain visual analog scale (VAS), number of daytime frequency, and nocturia. Pressure flow study was conducted for all patients. Intraoperative and postoperative changes and adverse events were recorded. Basal IC symptom indices, IC problem indices, and VAS scores were comparable between both groups (P = .31, .63, and .94, respectively). There was no statistically significant difference between both groups with respect to urodynamic parameters. Only pain VAS at first week was improved in SHN in comparison with HD (P = .012). Thereafter, all parameters were significantly improved in favor of the HD group at 2- and 4-week visits. Adverse events in both groups were ranked as Grade 1 Clavien-Dindo classification including transient hematuria in the HD group and transient back ache in the SHN group. Despite effective pain control in cases with IC-BPS after SHN, it lacks durability. It seems that SHN in its current form is not to be a suitable line of treatment for IC-BPS. Multimodality treatment would be needed for proper control of patients' symptoms.

Efficacy comparison of interstitial cystitis/painful bladder syndrome patients treated with four-drug combination and sodium hyaluronate intravesical instillation

Objective To compare the outcomes between interstitial cystitis/painful bladder syndrome (IC/PBS) patients treated with four-drug combination (heparin, lidocaine, sodium bicarbonate, gentamicin) and sodium hyaluronate intravesical instillation. Methods There were 23 IC/PBS patients from Jan. 1, 2011 to Mar. 1, 2013. Ten patients (group A) received four-drug combination (heparin 40 000 U, gentamicin 160 000 U, sodium bicarbonate 1%, lidocaine 0.4%) instillation treatment. Thirteen patients received instillation of sodium hyaluronate (40 mg/50 ml) therapy (group B). In group B, intravesical instillations were performed weekly in the first 6-8 weeks, and monthly until one year. Patients in group A received intravesical instillation twice a week in the first 6-8 weeks and twice a month for 10 months. All the patients were instructed to retain the instillation volume for at least one hour. Clinical symptoms (24 h frequency of urination, maximal micturition volume), O′Leary-Sant symptom and problem index were assessed at baseline and 1, 6 and 12 months after treatment. The 2 therapies were compared within curative effects and side effects. Results Twenty-two of the 23 patients were followed up to 12 months. Patients in group A had no adverse events reported. One case of group B dropped out from treatment for recurrent urinary tract infection, and the other two cases felt painful in bladder area during instillation. There was no significant difference in initial scores between the 2 groups (P>0.05). At 1, 6, 12 months after intravesical instillation, interstitial cystitis symptom index, interstitial cystitis problem index, 24 h frequency of urination, the maximum bladder capacity were improved in both groups. All indicators in group A and B were improved significantly after treatment compared with pretreatment (P 0.05). Conclusion The four-drug combination intravesical instillation could achieve a similar effect with hyaluro-nic acid therapy in patients with IC/PBS. Key words: Interstitial cystitis/painful bladder syndrome; Four-drug combination; Sodium hyaluronate; Intravesical instillation

Sex differences in risk factors for interstitial cystitis/painful bladder syndrome in patients with lower urinary tract symptoms in China

AimThe aim of the present study was to identify sex differences of risk factors for interstitial cystitis (IC)/painful bladder syndrome (PBS) in patients with lower urinary tract symptoms (LUTS) without urinary tract infection or benign prostate hyperplasia in China.Patients and MethodsA total of 954 outpatients with LUTS presenting for care to urology clinics in many hospitals on a national scale were surveyed using a standardized questionnaire. The definitions for PBS, based on the O'Leary–Sant IC symptom and problem indices, was used. The prevalence of possible risk factors was analysed using the Fisher's exact test, Pearson's χ2‐test and binary logistic regression methods.ResultsOf the multicentre patients surveyed (491 women and 463 men), 44.7 per cent (427/954) met the criteria for PBS. There was a significant difference between women and men [51.7 per cent (254/491) vs 37.3 per cent (173/463), P &gt; 0.05]. After adjusting for confounding factors, bladder pain was found to be significantly associated with the consumption of stimulatory foods [odds ratio (OR): 3.85, 95 per cent confidence interval (CI): 1.58–9.36, P = 0.003] and anorectal disease (OR: 2.76, 95 per cent CI: 1.09–7.04, P = 0.03) in women. Caffeine beverage intake (OR: 3.54, 95 per cent CI: 1.54–8.12, P = 0.003) was identified the only modifiable association noted in a multivariate analysis of men. Factors in men significantly associated with an increased risk of IC/PBS were the consumption of caffeinated beverages (OR: 1.43, 95 per cent CI: 1.16–1.75, P = 0.001) and holding in urine (OR: 1.18, 95 per cent CI: 1.03–1.36, P = 0.034).ConclusionsA higher incidence of IC was founded in LUTS outpatients without urinary tract infection or benign prostate hyperplasia in China. Stimulating foods, irritable bowel, gynaecologically‐infected diseases and anorectal disease are potential risk factors for IC/PBS in women. Caffeinated beverages and holding in urine are potential risk factors for IC/PBS in men.

MP27-04 A PSYCHOMETRIC ANALYSIS OF PAIN AND URINARY SYMPTOMS IN PATIENTS WITH INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME AND CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME: FINDINGS FROM MAPP RESEARCH NETWORK

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality of Life1 Apr 2015MP27-04 A PSYCHOMETRIC ANALYSIS OF PAIN AND URINARY SYMPTOMS IN PATIENTS WITH INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME AND CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME: FINDINGS FROM MAPP RESEARCH NETWORK James Griffith, Todd Edwards, Barry Hong, Siobhan Sutcliffe, Michel Pontari, Niloofar Afari, John Krieger, Robert Lloyd, Frank Tu, David Williams, Donald Patrick, Jayoung Kim, Bruce Naliboff, Henry Lai, Catherine Bradley, Chris Mullins, and Richard Landis James GriffithJames Griffith More articles by this author , Todd EdwardsTodd Edwards More articles by this author , Barry HongBarry Hong More articles by this author , Siobhan SutcliffeSiobhan Sutcliffe More articles by this author , Michel PontariMichel Pontari More articles by this author , Niloofar AfariNiloofar Afari More articles by this author , John KriegerJohn Krieger More articles by this author , Robert LloydRobert Lloyd More articles by this author , Frank TuFrank Tu More articles by this author , David WilliamsDavid Williams More articles by this author , Donald PatrickDonald Patrick More articles by this author , Jayoung KimJayoung Kim More articles by this author , Bruce NaliboffBruce Naliboff More articles by this author , Henry LaiHenry Lai More articles by this author , Catherine BradleyCatherine Bradley More articles by this author , Chris MullinsChris Mullins More articles by this author , and Richard LandisRichard Landis More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1166AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Approaches are needed to better characterize the course of interstitial cystitis/bladder pain syndrome (IC/BPS) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), conditions which are collectively referred to as urologic chronic pelvic pain syndromes (UCPPS). As part of a prospective observational study within the Multi-Disciplinary Assessment of Pelvic Pain (MAPP) Research Network, patients diagnosed with IC/BPS and CP/CPPS completed a battery of questionnaires. The purpose of this research was to examine the number of factors among a large set questionnaire items, which helps to understand the symptom structure of pelvic pain, as well as to create simple indices to characterize changes in symptoms. METHODS MAPP participants (N = 424) completed a battery of baseline questionnaires, including the American Urological Association Symptom Index (AUA-SI), the Interstitial Cystitis Symptom Index and Problem Index (ICSI, ICPI), the Genitourinary Pain Index (GUPI), and symptom scales developed specifically for the MAPP. These questionnaire items were examined with exploratory factor analyses. RESULTS Using items from the ICSI, ICPI, and GUPI, two factors accounted for 56% of the variance and provided a good fit to this set of questionnaire items. These factors were rotated using an oblique rotation, which allows the factors to be correlated. These two factors represented pelvic pain symptoms versus urinary symptoms, which were correlated, r =.5. Based on these factor analysis results and further elimination of redundant items (the four items from the ICPI), we created two simple indices: 1) The GUPI pain scale + the ICSI bladder pain question, and 2) The GUPI urinary scale + the 3 ICSI questions about urinary symptoms. These two scales recapitulated most of the variance found in the two factors (r's >=.92). These two indices were then explored with regard to other variables of interest. For example, depression was measured by the Hospital Anxiety and Depression Scale was predicted by pain (β =.3, p <.001), but not by urinary symptoms (β <.1, ns) in a simultaneous regression. CONCLUSIONS UCPPS can be measured using two simple indices. Two meaningful factors are evident (pain versus urinary symptoms), and these two factors show differential relationships with important comorbidities, such as depression. Future analyses within MAPP will characterize symptom changes over time and study their relationship with other comorbid symptoms and biomarkers. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e303 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information James Griffith More articles by this author Todd Edwards More articles by this author Barry Hong More articles by this author Siobhan Sutcliffe More articles by this author Michel Pontari More articles by this author Niloofar Afari More articles by this author John Krieger More articles by this author Robert Lloyd More articles by this author Frank Tu More articles by this author David Williams More articles by this author Donald Patrick More articles by this author Jayoung Kim More articles by this author Bruce Naliboff More articles by this author Henry Lai More articles by this author Catherine Bradley More articles by this author Chris Mullins More articles by this author Richard Landis More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD20-12 MICROVASCULAR INJURY IN KETAMINE-INDUCED BLADDER DYSFUNCTION

PD20-12 MICROVASCULAR INJURY IN KETAMINE-INDUCED BLADDER DYSFUNCTION

PD20-03 PILOT STUDY EVALUATING SAFETY AND FEASIBILITY OF INTRAVESICAL INSTILLATION OF BOTULINUM TOXIN IN HYDROGEL-BASED SLOW RELEASE DELIVERY SYSTEM IN PBS/IC PATIENTS

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Interstitial Cystitis1 Apr 2015PD20-03 PILOT STUDY EVALUATING SAFETY AND FEASIBILITY OF INTRAVESICAL INSTILLATION OF BOTULINUM TOXIN IN HYDROGEL-BASED SLOW RELEASE DELIVERY SYSTEM IN PBS/IC PATIENTS Kobi Stav, Yuri Vinshtok, Michal Jeshurun, Neely Ivgy-May, Tami Gerassi, and Amnon Zisman Kobi StavKobi Stav More articles by this author , Yuri VinshtokYuri Vinshtok More articles by this author , Michal JeshurunMichal Jeshurun More articles by this author , Neely Ivgy-MayNeely Ivgy-May More articles by this author , Tami GerassiTami Gerassi More articles by this author , and Amnon ZismanAmnon Zisman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.674AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Intravesical instillation of botulinum toxin-A (BTX) is an appealing alternative to intradetrusor injection for treating painful bladder syndrome/interstitial cystitis (PBS/IC) but lacks a sustained effect due to a short exposure of urothelium to BTX. TCGel (TheraCoat Ltd) is a novel reverse-thermal gelation hydrogel allowing for instillations of liquid TCGel+BTX mixture into the bladder where it solidifies and BTX gradually releases for 6-8 hours. We investigated the feasibility and safety of intravesical instillation of BTX dissolved in TCGel preparation in patients with PBS/IC. METHODS A single intravesical instillation of 200U onabotulinumtoxin-A premixed with 40ml TCGel through 12Fr urethral catheter was delivered. Adverse events (AEs) and preliminary efficacy outcome measures were: bladder diary, Visual Analogue Scale (VAS), IC symptom and problem index (ICSI, ICPI). They were assessed at 2, 6 and 12 weeks following instillation. RESULTS 15 (M/F=4/11, age 24-76) severely symptomatic PBS/IC patients (ICSI range 12-19, ICPI range 12-16, median VAS=7) were enrolled. Safety: No increase in VAS score was noted at instillation. One severe AE was reported - an excisional biopsy of pre-existing sub-mandibular lymphadenopathy (benign histology). Three cases of mild constipation 24h to 3 weeks following instillation were noted as possibly drug-related AE's. Non-related AEs include post-instillation mild urogenital infection, flu and a case of worsening of bladder pain and depression symptoms at Week 12. Possible efficacy: Reduction in ICSI, ICPI and VAS was maintained throughout the follow-up period. Voiding frequency, nocturia and urge decreased up to Week 6 but returned to baseline level at Week12 (figure). CONCLUSIONS The results suggest that intravesical instillation of the novel TCGel+BTX is safe and tolerable. Preliminary results suggest sustained efficacy for weeks. A randomized controlled trial is warranted. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byTyagi P, Kashyap M, Yoshimura N, Chancellor M and Chermansky C (2016) Past, Present and Future of Chemodenervation with Botulinum Toxin in the Treatment of Overactive BladderJournal of Urology, VOL. 197, NO. 4, (982-990), Online publication date: 1-Apr-2017. Volume 193Issue 4SApril 2015Page: e398 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kobi Stav More articles by this author Yuri Vinshtok More articles by this author Michal Jeshurun More articles by this author Neely Ivgy-May More articles by this author Tami Gerassi More articles by this author Amnon Zisman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Psychological changes in patients with interstitial cystitis after hydrodistension

Objective To evaluate the effect of hydrodistension on interstitial cystitis and the psychological changes after hydrodistension. Methods Thirty two patients with interstitial cystitis underwent hydrodistension from May 2011 to Jun 2012 in Department of Urology, Beijing Hospital. Interstitial cystitis symptom index(ICSI), Visual onalogue Scale(VAS) pain score, quality of life questionnaire(QOL)score, self-rating anxiety scale(SAS) score, self-rating depression scale(SDS)score were recorded and analyzed before and at 1-3 month after hydrodistension surgery. The voiding diary and postoperative complications were cared. Results Symptoms were improved in twenty nine patients, the efficiency rate was 90.6% (29/32). There were significant differences in ICSI score, VAS pain score, QOL score, SAS score, SDS score between pre and 3 month post-surgery 〔(26.7±2.3) vs. (15.2±1.9), (4.6±2.5) vs. (1.8±1.1), (4.3±2.2) vs. (2.2±1.6), (53.8±3.7) vs. (40.8±2.3), (54.8±2.3) vs. (42.4±1.5), t=8.33, 7.94, 6.54, 7.20, 8.62, respectively, all P<0.05〕. No complication was found after surgery. Both the clinical symptoms and the anxiety and depression symptoms in patients were relieved, and QOL was improved. Conclusions For the patients with interstitial cystitis, the undergoing of hydrodistension surgery can relieve the anxiety and depression symptoms and improve quality of life. Key words: Dilatation; Cystitis, interstitial; Anxiety; Depression

Sacral neuromodulation for the treatment of painful bladder syndrome/interstitial cystitis: preliminary results

Objective To evaluate the effectiveness and safety of sacral neuromodulation for the treatment of painful bladder syndrome/interstitial cystitis. Methods There were 21 painful bladder syndrome/interstitial cystitis patients treated during April 2012 to October 2014. Behavior therapy, oral therapy, intravesical instillation of sterile sodium hyaluronate, water expansion of bladder, bladder submucosal injection of botulinum toxin type A and so on did not have a good effect on the patients. The data of voiding diary, visual pain scale, interstitial cystitis symptom index and quality of life score were collected. The time of follow-up was 2 week, 3 month and 6 month after the surgery. Then the patient was followed up every 6 months.Those individuals demonstrating a 50% reduction in voiding diary, visual pain scale, interstitial cystitis index and the quality of life score were eligible for surgical placement of a permanent device. Results Three of them refused to accept InterStim therapy because of failure of experimental therapy. Eighteen of them received InterStim long term implantation therapy. The rate of long term implantation was 86%. The average follow-up time was 18 months. Before the surgery, the average voiding times of 24 hours, the times of nocturia, the voiding volume, the visual pain score, the interstitial cystitis problem index, interstitial cystitis symptom index and the quality of life score were 23.2±7.1, 13.0±4.7, 73.3±12.9 ml, 7.2±1.1, 15.6±1.3, 14.1±1.8, 5.6±0.5. After surgery, the data were 11.1±3.2, 5.9±2.1, 164.4±28.5 ml, 3.4±0.8, 7.0±0.7, 6.6±1.0, 1.9±1.0, respectively. And there were significant differences (P<0.05). There was no complication such as infection, electrode displacement, electrode fracture and so on. Conclusion Results of this initial clinical study demonstrate that sacral neuromodulation is safe and effective for refractory painful bladder syndrome Key words: Sacral neuromodulation; Urination disorders; Urine control; Cystitis, interstitial; Painful bladder syndrome

Prevalence of lower urinary tract symptoms and level of quality of life in men and women with chronic pelvic pain

Objectives. The aim of this study was to evaluate the prevalence of lower urinary tract symptoms and quality of life in patients with chronic pelvic pain syndrome (CPPS). Materials and methods. The McGill Pain Questionnaire, Dutch Leiden/Leuven Version (MPQ-DLV), Pain Disability Index (PDI), National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), Interstitial Cystitis Symptom Index (ICSI) and Pelvic Pain and Urinary/Frequency Symptom Scale (PUF) were used, based on their specific properties, to assess the symptoms and impact on the quality of life. Total scores and domains were compared for gender. Results. The studied group (N = 35; 18 male, 17 female) showed a good distribution in gender for age [Mann–Whitney U test (MW-U) p = 0.4] and body mass index (MW-U p = 0.2). The MPQ-DLV showed significantly higher scores for pain in women for Pain Rating Index – Affective (MW-U p = 0.030) and Total (MW-U p = 0.031), and Visual Analogue Scale for Pain – Most (MW-U p = 0.005). Women were less sexually active (PUF-SA) (chi-squared test p = 0.021) and had a significantly higher disability (PDI-T) (MW-U p = 0.005) and MPQ – Quality of Life (MW-U p = 0.003). The urinary symptoms showed similar results for gender (chi-squared test p > 0.05). Conclusions. A wide variety of symptoms and a negative impact on quality of life were shown. No differences in lower urinary tract symptoms were found between genders. Women were less sexually active than men. Chronic pelvic pain had a significantly higher negative impact on the level of quality of life in women than in men.

Comparison of Baseline Urological Symptoms in Men and Women in the MAPP Research Cohort

The clinical features of the interstitial cystitis/bladder pain syndrome are similar to those of the chronic prostatitis/chronic pelvic pain syndrome. However, to our knowledge no studies have directly compared the characteristics of these syndromes in men and women. The MAPP Research Network recruited 191 men and 233 women with IC/BPS or CP/CPPS. Baseline data included demographics, Interstitial Cystitis Symptom Index and Problem Index scores; Genitourinary Pain Index score; American Urological Association Symptom Index score; Likert scales to assess urinary urgency, frequency, pain and overall symptom severity; and a single question about the most bothersome pelvic symptom. After adjustment for age, income and symptom duration, measures of pain severity were similar across genders. Mean scores for the ICSI, ICPI and AUASI were significantly higher in women than in men, reflecting more bladder focused symptoms in women. The most bothersome single symptom in men as well as in women was pain in the pubic/bladder area (men 34%, women 58%). The characteristics of the men and women in the MAPP cohort were similar to those reported in other research cohorts for IC/BPS and CP/CPPS. Our findings indicate that pain severity is similar for both genders and that bladder focused symptoms (urgency, suprapubic pain, frequency) are more common in women. However, a substantial proportion of men also reported these types of bladder symptoms.

Adding a Sexual Dysfunction Domain to UPOINT System Improves Association With Symptoms in Women With Interstitial Cystitis and Bladder Pain Syndrome

To examine whether adding a sexual dysfunction domain to urinary, psychosocial, organ specific, infection, neurologic or systemic, and tenderness (UPOINT) system improves the association with interstitial cystitis and bladder pain syndrome (IC-BPS) symptom severity due to a high prevalence of sexual dysfunction in women. A total of 90 Chinese women with IC-BPS were prospectively collected and classified in each domain of the UPOINT system. Symptom severity was measured using the Interstitial Cystitis Symptom Index (ICSI). The sexual function was evaluated using the Female Sexual Function Index (FSFI). Clinically relevant associations were calculated. The percentage of patients positive for each domain were 90 of 90 (100%), 33 of 90 (37%), 88 of 90 (98%), 21 of 90 (23%), 36 of 90 (40%), 38 of 90 (42%), 62 of 90 (69%) for the urinary, psychosocial, organ specific, infection, neurologic or systemic, tenderness, and sexual dysfunction, respectively. There were significant associations between the number of domains and ICSI (Spearman r = 0.386; P <.05) and FSFI (Spearman r = 0.614; P <.001) scores. After adding a sexual dysfunction domain to create a modified UPOINTS system, the association between the number of domains and symptom severity was improved (correlation coefficient r changed from 0.386 to 0.572; P <.001). The presence of sexual dysfunction had a significant impact on the ICSI scores (P = .032), pain scores (P = .042), and quality of life index scores (P = .035). Significantly reduced FSFI scores were found in patients who had positive psychosocial, organ specific, and tenderness domains (all P values <.05). Our study demonstrated sexual dysfunction was an important component of IC-BPS phenotype, and adding a sexual dysfunction domain to the UPOINT system improved the association with IC-BPS symptom severity.

Therapeutic effects and predictive factors for successful intravesical hyaluronic acid instillation in patients with interstitial cystitis/bladder pain syndrome

ObjectiveHyaluronic acid (HA) is currently used in Taiwan as intravesical instillation for the treatment of interstitial cystitis/bladder pain syndrome (IC/BPS). This study investigated the therapeutic effects of HA on IC/BPS in the Taiwanese population. Materials and methodsMen and women aged ≥18 years with documented IC/BPS were initially treated with four weekly intravesical HA instillations (treatment time, 1 month) and then with five monthly instillations (total treatment time, 6 months). Clinical assessments included the evaluation of the Visual Analog Scale (VAS) score of bladder pain, O'Leary–Sant Symptom (OSS) score, IC Symptom Index (ICSI), IC Problem Index (ICPI), functional bladder capacity (FBC), uroflowmetry parameters, and global response assessment (GRA). Therapeutic effects were compared between responders (GRA increased ≥ 2 scales) and nonresponders (GRA increased < 2). Multivariate linear analysis was used to determine predictive factor for successful treatment. ResultsA total of 64 patients (3 men and 61 women) with mean age of 49.4 years (range, 20–79) completed the study. Compared with the baseline data, VAS, ICSI, ICPI, OSS score, daytime frequency, nocturia, and FBC all improved at 1 month or 6 months after starting HA treatment. Significantly more improvements in ICSI, ICPI, OSS score, VAS, and FBC were noted in the responders than in the nonresponders at 6 months of treatment. A low-grade glomerulation was the only predictor for successful treatment response to intravesical HA treatment. ConclusionIntravesical HA administrations improved IC symptoms, decreased bladder pain, and decreased frequency after four instillations, and decreased nocturia and increased bladder capacity after completion of all nine instillations. Low-grade glomerulation predicts successful outcome.

Liposomal bladder instillations for IC/BPS: an open-label clinical evaluation.

Intravesical instillation of liposomes is a potentially new therapeutic option for subjects with interstitial cystitis/bladder pain syndrome (IC/BPS). The aim of this study was to explore the safety and clinical outcomes of 4 weekly instillations of sphingomyelin liposomes in an open-label cohort of subjects with IC/BPS. Fourteen symptomatic IC/BPS subjects were treated with intravesical liposomes once a week for 4 weeks. Safety measurements included laboratory specimen collection, vital signs, post-void residual, and assessment of adverse events (AEs). Efficacy measurements included pain visual analog scales (VAS), voiding diaries, global response assessments (GRAs), and O'Leary-Sant Interstitial Cystitis Symptom and Problem Indices (ICSI and ICPI). No treatment-related AEs were reported at any time over the course of the study. Urgency VAS scores significantly decreased at 4 weeks (p = 0.0029) and 8 weeks (p = 0.0112) post-treatment. Pain VAS scores significantly decreased at 4 weeks post-treatment (p = 0.0073). Combined ICSI and ICPI scores improved significantly at 4 and 8 weeks (p = 0.002 for both time points) post-treatment. Responses to GRA showed improvement at 4 weeks post-instillation. No significant decrease in urinary frequency was found. Sphingomyelin liposome instillations were well tolerated in subjects with IC/BPS with no AEs attributed to the test article. Treatment was associated with improvements in pain, urinary urgency, and overall symptom scores. Placebo-controlled clinical trials are needed to assess this potential therapy for IC/BPS.

Clinical comparision of intravesical hyaluronic acid and hyaluronic acid-chondroitin sulphate therapy for patients with bladder pain syndrome/interstitital cystitis.

Patients with a history of bladder pain syndrome/interstitial cystitis (BPS/IC) and who responded poorly or unsatisfactorily with previous treatment were compared taking intravesical hyaluronic acid (HA) or hyaluronic acid-chondroitin sulphate (HA-CS). Patients were treated with intravesical instillation with 50 mL sterile sodium hyalurinic acid (Hyacyst, Syner-Med, Surrey, UK) (n = 32) and sodium hyaluronate 1.6% sodium chondroitin sulphate 2% (Ialuril, Aspire Pharma, UK) (n = 33). Intravesical instillations were performed weekly in first month, every 15 days in the second month and monthly in third and fourth months, for a total of 8 doses. Patients were evaluated using a visual analog pain scale (VAS), interstitial cystitis symptom index (ICSI), interstitial cystitis problem index (ICPI), voiding diary for frequency/nocturia, cystometric bladder capacity and voided volume at the beginning and at 6 months. All patients had a potassium sensitivity test (PST) initially. Wilcoxon and Mann-Whitney U tests were used for statistical analysis. In total, 53 patients met the study criteria. There were 30 patients in the HA-CS group (mean age: 48.47) and 23 patients in the HA group (mean age: 49.61) (p > 0.05). The initial PST was positive in 71.7% patients (38/53) overall with no difference between groups (p > 0.05). Responses for VAS, ICCS, ICPS, 24-hour frequency/nocturia statistically improved in both groups at 6 months. There was no significant difference in symptomatic improvement (p > 0.05). Eight patients had mild adverse events. HA and HA/CS instillation can be effective in BPS/IC patients who do not respond to conservative treatment. An important limitation of our study is that the HA dosage of the 2 treatment arms were different. It would be more appropriate with same HA dosage in both groups; however, there was no commercially available glycosaminoglycan (GAG) substance with same HA dosage for single and combination therapy. Large, long-term randomized studies are required to determine if there is a difference between these treatments.

Changes in Sexual Function of Women with Refractory Interstitial Cystitis/Bladder Pain Syndrome after Intravesical Therapy with a Hyaluronic Acid Solution

Intravesical instillation with a hyaluronic acid (HA) solution is an effective treatment for interstitial cystitis/bladder pain syndrome (IC/BPS), but its impact on sexual functioning of patients is not known. The aim of this study was to evaluate the changes in sexual function of women with refractory IC/BPS who underwent a second-line intravesical HA therapy. A total of 103 women diagnosed with refractory IC/BPS were enrolled in this prospective, multicenter study. Sexual function was evaluated using the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-9). Bladder-related symptoms and bother were assessed by the Interstitial Cystitis Symptom Index (ICSI) and Interstitial Cystitis Problem Index (ICPI), and a pain visual analog scale (VAS), respectively. Data were analyzed with univariate methods or multivariate logistic regression analysis accordingly. Changes in PISQ-9, ICSI, ICPI, and pain VAS scores after treatment were assessed. Mean age and duration of symptoms was 43.6 ± 11.8 and 5.1 ± 5.0 years, respectively. ICSI, ICPI, and pain VAS scores were significantly (P < 0.001) improved after 1 month and 6 months of treatment. Of the 87 (84.5%) sexually active women evaluated, PISQ-9 total scores improved significantly (P < 0.001) from the baseline (mean 18.9 ± 6.4), after 1 month (20.4 ± 5.8), and 6-months (21.5 ± 5.6) of treatment. Significantly improved PISQ-9 items included "dyspareunia" (P < 0.001) and "negative reactions" (P = 0.015) during sexual intercourse, and "intensity" (P < 0.001) of sexual orgasms. After a logistic regression analysis, we found that a baseline PISQ-9 score was negatively correlated with the duration of IC/BPS symptoms (P = 0.022). Meanwhile, the changes in PISQ-9 scores were positively correlated with the reduction in ICSI scores after treatment (P = 0.045). Intravesical HA is an effective treatment for refractory IC/BPS. A longer duration of IC/BPS symptoms may be a predictor of poor sexual function. However, intravesical HA may improve sexual function along with the reduction of IC/BPS symptoms.

Examination of the Significant Placebo Effect in the Treatment of Interstitial Cystitis/Bladder Pain Syndrome

To examine the significant "placebo effect" in a randomized, double-blind, placebo-controlled interstitial cystitis/bladder pain syndrome trial. Randomized clinical trials are the reference standard for therapeutic impact assessment. However, proving efficacy of treatments for interstitial cystitis/bladder pain syndrome with rigorous placebo-controlled trials is difficult due to a significant effect of the placebo intervention. Interstitial cystitis/bladder pain syndrome patients were randomized to receive subcutaneous adalimumab or subcutaneous placebo every 2 weeks for 12 weeks and outcome measures were assessed. Of the 43 patients, 21 received adalimumab and 22 received placebo. Of the patients who received placebo, there was a statistically significant improvement demonstrated in the O'Leary-Sant Interstitial Cystitis Symptom and Problem Indexes of -8.1 (95% confidence interval [CI], 3.0-13.2), Interstitial Cystitis Symptom Index of -3.7 (95% CI, 0.9-6.5), Interstitial Cystitis Problem Index of -4.4 (95% CI, 2.0-6.8), and Pelvic Pain, Urgency, Frequency scale of -6.9 (95% CI, 2.8-11.0) at week 12 compared with baseline. Most of the significantly improved placebo patients felt their improvement was because they were more conscientious about following physician advice and feeling less stress while in the study. Patients with moderate to severe interstitial cystitis/bladder pain syndrome had significant improvement after receiving only advice and support. This intervention is risk free and inexpensive. Physicians should review standard advice with all interstitial cystitis/bladder pain syndrome patients before starting medical therapy.

Symptom persistence in a community cohort of women with interstitial cystitis/bladder pain syndrome (IC/BPS): 3-, 6-, 9-, and 12-month follow-up from the RICE cohort.

The persistence of interstitial cystitis/bladder pain syndrome (IC/BPS) symptoms has been described in women seeking medical care. The purpose of this study was to determine whether symptoms persist among a population-based sample of women. A probability sample of US women was identified through a two-stage telephone screening process using the Research and Development (RAND) Interstitial Cystitis Epidemiology (RICE) high-sensitivity case definition. A randomly selected subgroup (n = 508) was enrolled in a longitudinal study and interviewed about their symptoms at baseline, 3, 6, 9, and 12 months. Bivariate and multivariate linear regression analyses determined predictors of persistence of symptoms over the four waves. A total of 436 women with a mean age of 47.5 years responding to all waves were included in the analysis. Forty-one percent met the RICE high-sensitivity case definition at baseline and in all four waves; an additional 21 % met the definition at baseline and in three waves. Women with a college degree (+12 % vs. no college, p = 0.02) and who were younger (-5 % per decade of age, p < 0.01) had higher chances of symptom persistence at each wave. Scoring one standard deviation higher on the continuity of symptoms and the O'Leary-Sant Interstitial Cystitis Symptom index increased the chances of symptom persistence by 4 % and 2 %, respectively (both p < 0.01). The majority of women demonstrated symptom persistence across at least three of four waves over 12 months. These women tended to be younger, college-educated, and to have reported a history of greater continuity of symptoms and higher severity of symptoms at baseline.

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.