Interstitial Cystitis Symptom Research Articles

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

To 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). This 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. The 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. Modified 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.

Intravesical Interferon Therapy vs Hyaluronic Acid for Pain Among Female Individuals With Interstitial Cystitis

Interstitial cystitis (IC) is a debilitating condition. Although viral infection is a potential etiological cause, few studies have detected the effect of antiviral treatment. To determine the efficacy and safety of intravesical interferon instillation compared with hyaluronic acid in female patients with IC. This double-masked, randomized phase 2/3 clinical trial with parallel group design was implemented from October 2022 to April 2023 and had a 6-month follow-up period. The study was conducted at a single center. Eligible participants were female patients aged 18 to 70 years with a diagnosis of IC for more than 6 months. The last visit took place in October 2023. Data were analyzed between October and November 2023. Patients were randomized 1:1 to receive either intravesical instillation of interferon or hyaluronic acid. The primary end point was change in visual analog scale pain score. Secondary end points included changes in voiding frequency, functional bladder capacity, symptom index, and global response assessment. Adverse events were closely monitored. Among the 52 patients, the mean (SD) age was 50.0 (14.1) years and they were randomized to either the interferon group (26 [50%]) or hyaluronic acid (26 [50%]). The visual analog pain score showed the interferon group decreased more significantly than hyaluronic acid (-1.3; 95% CI, -2.3 to -0.3; P = .02) at month 6, with 20 patients (77%) exhibiting a 30% or higher reduction in pain compared with baseline. Secondary end points of voiding frequency, functional bladder capacity, and nocturia episodes showed no significant difference between 2 therapies. However, interferon showed a significantly higher reduction in the Interstitial Cystitis Symptom Index (-3.0; 95% CI, -5.3 to -0.7; P = .01) and the Problem Index (-2.5; 95% CI, -4.5 to -0.4; P = .02) at month 6, with 22 patients (85%) presenting as moderately or markedly improved. The frequencies of adverse events were similar between 2 groups. Only 1 patient discontinued hyaluronic acid because of poor effectiveness. In this randomized clinical trial, female patients with IC could benefit from intravesical interferon therapy, without serious adverse events. These results offered hope for antiviral approaches in IC, but larger-scale, multicenter trials and long-term follow-up should be considered. ClinicalTrials.gov Identifier: NCT05912946.

Does treatment with daily antihistamines decrease the severity of interstitial cystitis symptoms?

Does treatment with daily antihistamines decrease the severity of interstitial cystitis symptoms?

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.

Improvement in chronic pelvic pain, orthostatic intolerance and interstitial cystitis symptoms after treatment of pelvic vein insufficiency.

Comorbidities associated with venous origin chronic pelvic pain (VO-CPP) were evaluated pre and post venous treatment to assess change. 45 women with VO-CPP were treated with venous stenting and/or embolization. Four surveys assessed symptoms pre- and post-treatment: IPPS (chronic pelvic pain), PUF (interstitial cystitis), OHQ (dysautonomia), and modified ROME III (IBS). Prevalence of joint hypermobility was investigated. Ages were 18-65. Pretreatment, 64% and 49% of women were in the severe range for PUF and OHQ, respectively. 40% and 56% met criteria for IBS and Ehlers-Danlos syndrome/Hypermobility Spectrum Disorder (EDS/HSD), respectively. 17eceived an iliac stent, 5 pelvic embolization, and 23 both. Post-treatment, average scores improved: IPPS (by 55%), PUF (34%), and OHQ (49%). Rome III improved only slightly. Pelvic pain, interstitial cystitis, and dysautonomia were frequently found with VO-CPP and improved after venous treatment. EDS/HSD and IBS were common in these women.

Effects of electroacupuncture on refractory interstitial cystitis/bladder pain syndrome: A one-year follow-up case report

BackgroundPatients with interstitial cystitis/bladder pain syndrome (IC/BPS) commonly face a decline in their quality of life and social functioning upon discontinuation of conventional therapy, which is known for its limited efficacy and the risk of relapse. While the existing evidence is somewhat restricted, acupuncture is being explored as a potential and effective treatment option for IC/BPS. Case presentationA 67-year-old woman, diagnosed with refractory IC/BPS, underwent treatment at the Medical Acupuncture Department of Sanming Integrated Traditional Chinese and Western Medicine Hospital. She reported symptoms of lower urinary system dysfunction, including urgency, frequency, and nocturia, along with chronic pelvic pain, and a persistent feeling of pressure and discomfort lasting over 8 years. The patient's visual analog scale (VAS) score for pelvic pain was 7 points prior to receiving acupuncture treatment. Throughout the day, she had more than 10 urinations, and at night, she urinated about once per hour. The O'Leary-Sant interstitial cystitis symptom index/interstitial cystitis problem index (ICSI/ICPI) score was 34 points, and the pelvic pain and urgency frequency (PUF) score was 19 points. ResultsThe patient's complaints were significantly alleviated after 12 sessions of electroacupuncture treatment at BL32, BL33, BL35, and SP6 over 4 weeks. The patient claimed total relief from pelvic pain, with a VAS score of 0. The patient achieved a PUF score of 4 points and an ICSI/ICPI score of 7 points. In addition, there was a significant reduction in the frequency and urgency of urination. The patient experienced a frequency of 4–5 urinations during the day and 1–2 times at night. Subsequently, the patient's mental state and sleep quality were improved. The patient's symptoms did not change at one-year follow-up. ConclusionElectroacupuncture has proven to be an effective management method for IC/BPS, as evidenced by the patient's alleviated lower urinary system symptoms and reduced pelvic pain.

Research on symptoms composition, time series evolution, and network visualisation of interstitial cystitis based on complex network community discovery algorithm.

We analyzed the symptoms composition of Interstitial Cystitis (IC), the regularity of the evolution of symptoms before and after treatment, and the visualization of the community network, to provide a reference for clinical diagnosis and treatment of Interstitial Cystitis. Based on the outpatient electronic case data of 552 patients with Interstitial Cystitis, we used a complex network community discovery algorithm, directed weighted complex network, and Sankey map to mine the data of the symptoms composition of Interstitial Cystitis, the evolution of symptoms before and after treatment and the visualization of the community network, to analyze the epidemiological characteristics of interstitial cystitis symptoms in the real world. By the community division of the complex network of interstitial cystitis symptoms, We finally obtained three core symptom communities. Among them, symptom community A (bladder-related symptoms) is the symptom community with the highest proportion of nodes (60.00%) in the complex network of Interstitial Cystitis, symptom community B (non-bladder-related symptoms 1) ranks second (32.00%) in a complex network of Interstitial Cystitis, and symptom community C (non-bladder-related symptoms 2) has the lowest proportion (8.00%). There is a complex evolutionary relationship between the symptoms of Interstitial Cystitis before and after treatment. Among the single symptoms before and after treatment, the decreased rate of Day frequency is 93.22%, and the reduced urgency rate is 93.07%. The decline rate of Nocturia was 82.33%. From the perspective of different communities, theoverall symptoms of symptom community A decreased by 34.39% after treatment, the general symptoms of symptom community B decreased by 35.37%, and the prevalent symptoms of symptom community C decreased by 71.43%. In the case of using diet regulation treatment to treat bladder pain, the cure rate of bladder pain can reach 22.67%. The cure rate of burning in bladders can get 15.38% with Percutaneous Sacral neuromodulation, 96.95% with diet regulation treatment, and 100% with Percutaneous Sacral neuromodulation. When using behavioral physiotherapy to treat bladder pain, 3.57% of the patient's symptoms change to bladder discomfort; 4% of the patient's symptoms change to bladder discomfort when using oral medicine to treat bladder pain.Symptom research methods based on community findings can effectively explore the rule of symptom outcome of Interstitial Cystitis before and after treatment, and the results are highly interpretable by professionals. The cover image is based on the Original Article Research on symptoms composition, time series evolution, and network visualisation of interstitial cystitis based on complex network community discovery algorithm by Lei Pang etal., https://doi.org/10.1049/syb2.12083.

Quality of life and healthcare resource use in patients with bladder pain syndrome: A survey of UK patients

Objectives: The main aim of this study is to characterise the humanistic burden of bladder pain syndrome (BPS) on patients within the United Kingdom and to estimate the key healthcare resource usage and cost of treating these patients. Method: An online survey was administered through two charities. Respondents were asked questions on BPS diagnosis, socio-demographics and health-related quality of life using the O’Leary-Sant Interstitial Cystitis Symptom Index (ICSI) and Problem Index (ICPI), the Pelvic Pain and Urinary/Frequency (PUF) and the EQ-5D questionnaires. Healthcare resource and therapy use, for the previous 6 months, were recorded and used to calculate economic burden. Results: A total of 252 patients completed the survey. Mean ICSI ICPI scores were 12.6 and 11.0, respectively, indicating severe symptoms. Mean PUF score was 21.2, indicating poor health status and a high number of BPS-related symptoms and problems. Mean EQ-5D utility score was 0.541. In the previous 6 months, 172 (68%) saw their general practitioner (GP) and 80 (32%) a primary care nurse, and 165 (65%) had one or more outpatient visits, due to their BPS. Conclusion: This survey adds to our current understanding of BPS in the United Kingdom, highlighting that patients with BPS have poor health-related quality of life and incur high resource use. Level of evidence: Not applicable

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.

Our 11-Year Experience With Percutaneous Tibial Nerve Stimulation in Men and Women for the Treatment of Interstitial Cystitis/Bladder Pain Syndrome

To evaluate the effect of percutaneous tibial nerve stimulation (PTNS) in interstitial cystitis/bladder pain syndrome (IC/BPS). Retrospective chart review was completed for patients with at least 10 weekly treatments of PTNS from January 2010 to October 2021. PTNS success was defined as conversion to PTNS maintenance therapy following 12weeks of PTNS induction therapy. Data were analyzed using GraphPad. Over the 11-year study period, 27 out of 34 patients (mean age 52.9±16.8years; 25 females, 9 males) completed 12weeks of PTNS induction therapy, and 48.1% (13/27) successfully converted to PTNS maintenance therapy. Following 12weeks of PTNS induction therapy, significant improvements were noted in the urgency severity scale (range 0-4: 2.9±1.2 before vs 1.1±1.1 after PTNS, P=.001) and nocturnal urinary frequency (number of voids: 3.3±1.9 before vs 2.2±1.6 after PTNS, P=.041); and nonsignificant improvements were noted in daytime void frequency (hours: 1.5±0.7 before vs 2.0±0.9 after PTNS, P=.090) and the pain domain of the interstitial cystitis symptoms index (question 4, range 0-4: 2.5±1.4 before vs 1.3±1.8 after PTNS, P=.082). Our sample size is among the largest sample of PTNS in IC/BPS from a single center. While PTNS achieved nonsignificant improvements in pain and daytime void frequency, significant improvements were observed in urinary urgency and nocturia. PTNS appears to be a plausible option in the multimodal approach to managing IC/BPS.

Serum anandamide and lipids associated with linoleic acid can distinguish interstitial cystitis/bladder pain syndrome from overactive bladder: An exploratory study.

Diagnosing interstitial cystitis/bladder pain syndrome presents a major challenge because it relies on subjective symptoms and empirical cystoscopic findings. A practical biomarker should discriminate diseases that cause increased urinary frequency, particularly overactive bladder. Therefore, we aimed to identify blood biomarkers that can discriminate between interstitial cystitis/bladder pain syndrome and overactive bladder. We enrolled patients with Hunner-type interstitial cystitis (n = 20), bladder pain syndrome (n = 20), and overactive bladder (n = 20) and without lower urinary tract symptoms (controls, n = 15) at Ueda Clinic and Nara Medical University Hospital from February 2020 to August 2021. The degree of interstitial cystitis/bladder pain syndrome symptoms was evaluated using the interstitial cystitis symptom and problem indices. Metabolomics analysis was performed on 323 serum metabolites using liquid chromatography time-of-flight mass spectrometry. In the Hunner-type interstitial cystitis or bladder pain syndrome group, we observed smaller relative areas, including anandamide, acylcarnitine (18:2), linoleoyl ethanolamide, and arachidonic acid, compared to those in the overactive bladder or control group. Notably, the differences in the relative areas of anandamide were statistically significant (median: 3.950e-005 and 4.150e-005 vs. 8.300e-005 and 9.800e-005), with an area under the curve of 0.9321, demonstrating its ability to discriminate interstitial cystitis/bladder pain syndrome. Serum anandamide may be a feasible diagnostic biomarker for interstitial cystitis/bladder pain syndrome. Reduced serum anandamide levels may be associated with pain and inflammation initiation, reflecting the pathology of interstitial cystitis/bladder pain syndrome. Furthermore, our findings suggest that abnormal linoleic acid metabolism may be involved in the pathogenesis of interstitial cystitis/bladder pain syndrome.

Validation study of new clinical scoring - "Apollo Clinical Scoring system" for bladder pain syndrome/interstitial cystitis and comparison of outcome with standard "O'Leary-Sant score".

Validation of the recently published newer clinical scoring system for bladder pain syndrome/interstitial cystitis and comparison of the results with the pre-existing standard O'Leary-Sant score. The symptoms are our primary guide to disease severity analysis, treatment, and response monitoring. The combined ICSI/ICPI (O'Leary-Sant Interstitial Cystitis Symptom and Problem Index) consist of a four-item symptom and problem index focusing on urgency, frequency, nocturia, and pain. A new scale, assigning more weight to pain and nocturia and adding the domains of sexual dysfunction and psychological impact, has been published by one of the authors (El Khoudary et al. J Women's Health 2002. 18:1361-1368; 7). This is a prospective study conducted to validate a newer clinical scoring system, namedht e 'Apollo Clinical Scoring' (ACS) system for patients with bladder pain syndrome/ interstitial cystitis (BPS/IC), and to compare its outcome with the simultaneously applied standard O'Leary-Sant (OLS) score. Thirty-five patients of BPS/IC diagnosed using the ESSIC definition were enrolled in the study and followed for 6 months. Intraclass correlation coefficient (ICC) for test-retest reliability, and Cronbach's α for measure of internal consistency, were applied to both scoring systems. Intraclass correlation coefficient for ACS was 0.715 and for OLS was 0.689. Cronbach's α for ACS was 0.736 and for OLS was 0.698. The present study suggests that the recently devised Apollo Clinical Scoring (ACS) system for patients of BPS/IC is internally consistent and a reliable scoring system. When compared with OLS in parallel setting, the newer ACS appeared to be marginally better.

Laser Treatment for Patients With Vulvodynia and Interstitial Cystitis/Bladder Pain Syndrome: A Case Series (The UNICORN-3 Study).

Introduction Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic pain disorder characterized by urgency, frequency of urination, and pelvic pain. Women with IC/BPS often experience sexual dysfunction, vulvodynia, and vaginal health issues. Combined erbium and neodymium yttrium aluminum garnet (YAG) laser treatments targeting the vagina and vulva have shown promise in improving symptoms. Our study aims to investigate the effectiveness of these combined laser treatments in women with IC/BPS and vulvodynia. Methods Women diagnosed with vulvodynia and IC/BPS underwent combined laser treatment using vaginal erbium:YAG laser (VEL) and neodymium:YAG laser (Nd:YAG). Various parameters were evaluated, including the vulvodynia test, numeric rating scale (NRS-11) for pain, interstitial cystitis symptom index and problem index (ICSI and ICPI), pelvic painand urgency/frequency symptom score (PUF), and mean urination volume/daily urination frequency in a three-day urination diary. Treatment was administered three times, with intervals of one month between each session, and follow-up evaluations were conducted at six and 12 months. All statistical analyses were designed and programmed by the AI chatbot GPT-4 (chatGPT-4). Results Fifteen female patients diagnosed with vulvodynia and IC/BPS were treated with three sessions of VEL + Nd:YAG. Significant improvements were observed in the vulvodynia test, NRS-11 scores, PUF, ICSI scores, ICPI scores, mean urination volume, and daily urination frequency at six and 12 months (p<0.01). Short-term improvements in IC/BPS pain scores correlated with improvements in the vulvodynia test (p=0.007), suggesting a synergistic effect. However, no significant correlations were found at 12 months. Conclusion Combined laser treatments targeting the vagina and vulva showed significant therapeutic effects in women with IC/BPS and vulvodynia. The addition of Nd:YAG to the VEL treatment enhanced outcomes. Short-term improvements in IC/BPS pain scores correlated with improvements in the vulvodynia test, indicating a synergistic effect. Long-term improvements in both vulvodynia and IC/BPS symptoms may occur independently.These findings highlight the importance of comprehensive approaches for treating coexisting vulvodynia and IC/BPS.

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.

Impact of chronic pelvic pain and painful bladder syndrome on the Pittsburgh Sleep Quality Index on women with deep endometriosis: a cross-sectional study.

Painful bladder syndrome (PBS) is frequently associated with deep endometriosis (DE), and both conditions cause chronic pelvic pain (CPP), which often impairs sleep quality. This study was aimed at analyzing the impact of CPP plus PBS in women with DE on the global sleep quality index using the Pittsburgh Sleep Quality Index (PSQI) and subsequently examine each sleep dimension. One hundred and forty women with DE were included and answered the PSQI and the O'Leary-Sant Interstitial Cystitis Symptoms and Problem Index questionnaires with or without CPP. Women were categorized into good or poor sleepers using the PSQI cutoff; subsequently, a linear regression model was used to analyze the PSQI score and a logistic regression model for each questionnaire's sleep component. Only 13% of women with DE had a good sleep. Approximately 20% of those with DE but no/mild pain were good sleepers; 138 women with DE (88.5%), 94% with PBS, and 90.5% with moderate/severe pain were poor sleepers. For PSQI components, CPP worsened the subjective sleep quality by more than threefold (p = 0.019), increased sleep disturbances by nearly sixfold (p = 0.03), and decreased the sleep duration by practically sevenfold (p = 0.019). Furthermore, PBS increased sleep disturbances by nearly fivefold (p < 0.01). The addition of PBS to CPP in women with DE is devastating for overall sleep quality, probably because it impacts some sleep dimensions unaffected by CPP and amplifies the problem in those already affected by pain.

(127) Dyspareunia as a Symptom of Urinary Tract Infection

Abstract Introduction In 2010, our center presented to the annual congress for the society for the scientific study of sex, research related to the sexual attitude and behavior of Hispanic women in our area. We interviewed and assessed 3,000 patients and discovered in the analysis of the data that dyspareunia was associated with 1,333 patients between the ages of 17-72, co-occurring with urinary tract infection (UTI). In approximately 83.7% of total UTI cases, patients were also positive for dyspareunia. We have reviewed the literature and corroborate that dyspareunia has never been described as part of the symptomatology of UTI. Since then, we have continued to confirm these findings through the follow-up of thousands of women over the last 12 years. Objective This study demonstrates how dyspareunia is one of the most important symptoms of UTI, along with the clinical symptoms of pollakiuria, dysuria, urodynia, nocturia, lower abdominal pain, headache, and fever. Methods We used an initial review in the area of sexuality in which we found a correlation between dyspareunia and UTI. Since 2010, we have followed thousands of women seen in our centers regarding the presence of dyspareunia as a symptom of UTI. Results In 83% of the UTI cases studied over the years, dyspareunia was endorsed as a symptom. Of these, approximately 94% of cases responded positively to treatment with antibiotics. Additionally, the dyspareunia gradually disappeared with the treatment of the UTI. We also found that 80% of women of reproductive age presenting with complaints of dyspareunia had an undiagnosed UTI. During the perimenopausal and postmenopausal years, dyspareunia is more often associated with genitourinary syndrome of menopause than UTI. Conclusions Dyspareunia has been described as one of the symptoms of interstitial cystitis but has never been implicated as a significant symptom of regular uncomplicated or complicated UTI. We have found that this symptom is extremely important as part of the symptomatology of the UTI, frequently found along with the classical symptoms of UTI. Why has something so clear, so frequently present, never been described? The answer is simple, physicians and patients do not talk about sex, despite dyspareunia being more a clinical symptom than a sexual one. Medical schools and residency programs in all areas, especially in obstetrics and gynecology, urology, and psychiatry, have neglected the education of physicians-in-training in this area of extreme importance for human health. In conclusion, this is proof of the unscientific way in which medicine has sometimes been influenced by religion, culture, and social norms. Disclosure No

Energy Alterations in Patients with Chronic Interstitial Cystitis Predisposing Them to Have Bladder Cancer

There are some studies in the literature showing an increased incidence of bladder cancer when the patient has a history of interstitial cystitis. Cancer in traditional Chinese medicine is caused when there is energy deficiency and Heat retention. The Purpose of this Study: Is to demonstrate that patients with interstitial cystitis have energy deficiency inside the five internal massive organs and when they are submitted to situations that can cause decrease even more of these energies, such as the use of highly concentrated medications (antibiotics, anti-inflammatory and anti-depressant medications), the vital energy can decrease and can cause more propensity to have cancer in the future. Methods: One case report of a patient with a history of chronic interstitial cystitis using several antibiotics to prevent and treat symptoms of urinary tract infection. She was very severe; the pain does not subside and the doctor was thinking about the possibility to take out the Bladder surgically. After this, they made a diagnosis of bladder cancer and she was submitted to treatment with BCG to cure her cancer. She returned to my clinic because she was having so many pains in the bladder without improvement using antibiotics and anti-inflammatory medications. I measured the energy of the five internal massive organs using the radiesthesia procedure. Results: All organs were in the lowest level of energy, rated one out of eight. The treatment of this condition was to orientate the patient to the dietary aspects and she was submitted to auricular acupuncture with apex and Bladder apex ear bloodletting. It was also prescribed highly diluted medications according to the theory of Constitutional Homeopathy of the five Elements Based on Traditional Chinese Medicine and crystal-based medications. The patient improved from her pain condition and she is very well nowadays without any symptoms of interstitial cystitis. The Conclusion of this Study: Is to demonstrate that patients with interstitial cystitis have energy deficiency inside the five internal massive organs and the use of highly concentrated medication can reduce this energy, causing more propensities to have cancer