Interstitial Cystitis Symptom Research Articles

Interstitial Cystitis-Critical Assessment of Current Treatment and Opportunities for Nanodelivery

Abstract: The characteristic feature of Interstitial cystitis (IC) or bladder pain syndrome is augmented, pressure, or inconvenience in the suprapubic or bladder region. The causative factors for IC are not completely understood however certain underlying disease condition may trigger the pain. The therapy is aimed to provide symptomatic relief, and therefore, the treatment protocols have been established based on experience. Intravesical delivery of drugs has been well explored and found to be most effective in minimizing the symptoms of IC without systemic adverse events. However, the efficacy of drug absorption is limited by the bladder wall permeability and poor absorption of the instilled drugs. The intravesical approach should be coupled with novel nanocarriers such as nanoparticles or liposomes to overcome these limitations. Nanoparticles can easily cross the bladder permeability barrier and enhance the drug retention time in the bladder, making the delivery efficient and promising. This review addresses the current IC management strategies, new potential therapeutic agents of natural origin, and various drugs undergoing clinical trials by different routes of administration. Keywords: IC, Bladder pain syndrome, Bladder permeability barrier, Intravesical delivery, Nanotherapeutics.

Vaginal non-ablative Er:YAG laser sexual dysfunction therapy in women with interstitial cystitis/bladder pain syndrome: A Case Series

ABSTRACT Introduction Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic debilitating disease characterized by urinary frequency, urgency, and pelvic pain. Different studies have evaluated sexual well-being and e female sexual dysfunction (FSD) in IC/BPS patients. FSD in women with IC/BPS consists of dyspareunia, altered sexual desire, reduced orgasm frequency and vaginal insufficient lubrication. Recently, it has been repeatedly demonstrated that vaginal non-ablative erbium YAG laser (VEL) therapy can improve objective and subjective symptoms in different conditions. In our experience, VEL was very effective in various indications (stress urinary incontinence, mixed urinary incontinence, overactive bladder, genitourinary syndrome of menopause and FSD). In this study we evaluated the effects of VEL on FSD in women suffering from IC/BPS. Materials and methods This is case series study in which women with IC/BPS were also reporting FSD. The patients were treated with VEL with protocol in which the laser firstly irradiated the whole anterior vaginal wall and then also the entire vaginal canal. Local topical anesthesia was applied to the vagina before the laser irradiation. The therapy consisted in 1 treatment every 30 days, for 3 months. For the assessment of treatment effects we evaluated the personal history including: age at onset of IC/BPS and FSD, type of IC/BPS, bladder IC/BPS surgeries, the numeric rating scale-11 (NRS-11), O'Leary-Sant interstitial cystitis symptom and problem indexes (ICSI and ICPI), functional bladder capacity, daily urinary frequency, female sexual function index (FSFI) and vaginal health index score (VHIS). Follow-up was done 6 months from the first laser session. Potential adverse effects were observed at every visit as well as at 6 months follow-up. Results Six women were treated with the three sessions of VEL and followed for 6 months. The FSFI and VHIS significantly improved in all patients. The NRS-11 scores and the part of pain question of ICSI and ICPI improved as well. The bladder capacity and daily urinary frequency showed a marginal improvement. The therapy effects lasted for 6 months from the first treatment. All observed adverse effects were mild and transient. Conclusion Women suffering from IC/BPS have often impaired sexual life. Our data suggest that, besides being safe, VEL treatment can improve sexual life reducing also pain symptoms in IC/BPS patients. Further larger studies are needed in order to ascertain the relations between vaginal conditions and bladder pain, evaluating the possible role of VEL as a new approach for the treatment of FSD in IC/BPS women. Disclosure Work supported by industry: no.

MP18-06 EFFICACY OF PULSED ELECTROMAGNETIC FIELD (PEMF) THERAPY FOR PELVIC PAIN REDUCTION AND SYMPTOM IMPROVEMENT IN INTERSTITIAL CYSTITIS: A PILOT STUDY

You have accessJournal of UrologyCME1 May 2022MP18-06 EFFICACY OF PULSED ELECTROMAGNETIC FIELD (PEMF) THERAPY FOR PELVIC PAIN REDUCTION AND SYMPTOM IMPROVEMENT IN INTERSTITIAL CYSTITIS: A PILOT STUDY Dylan T. Wolff, Peyton Lee, Christina Ross, Robert J. Evans, Gopal Badlani, Tyler Overholt, Raymond Xu, Catherine A. Matthews, and Stephen J. Walker Dylan T. WolffDylan T. Wolff More articles by this author , Peyton LeePeyton Lee More articles by this author , Christina RossChristina Ross More articles by this author , Robert J. EvansRobert J. Evans More articles by this author , Gopal BadlaniGopal Badlani More articles by this author , Tyler OverholtTyler Overholt More articles by this author , Raymond XuRaymond Xu More articles by this author , Catherine A. MatthewsCatherine A. Matthews More articles by this author , and Stephen J. WalkerStephen J. Walker More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002551.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: PEMF therapy is effective for pain reduction in select chronic pain disorders. The present study evaluated the efficacy of PEMF therapy for pain/symptom management in women with non-bladder centric interstitial cystitis/bladder pain syndrome (IC/BPS). METHODS: Women (ages 18-80 yo) with a confirmed diagnosis of IC/BPS, a numeric rating scale (NRS) score for pelvic pain ≥6, and an anesthetic bladder capacity (BC) >400ml underwent 8-minute full body PEMF sessions, twice daily, for 4 weeks. The primary outcome measure was a reduction in NRS score ≥ 2-points. The O’Leary Sant Interstitial Cystitis Symptom and Problem Indices (ICSI/ICPI), Pain and Urgency/Frequency (PUF) patient symptom scale, Female Genitourinary Pain Index (F-GUPI), and the Short Form-36 (SF-36) Quality of Life questionnaires, completed at weeks 1 (baseline), 4 (conclusion), and 12 (8-week follow-up), were used to assess secondary outcomes. A 7-day voiding diary was collected at baseline and 4 weeks. Treatment effects were assessed via Wilcoxon-signed rank test; p <0.05 = significant. RESULTS: Of 10 participants, 8 completed the 4-week treatment, and 7/8 (87.5%) had a significant reduction in pelvic pain (6.88 to 4.19, p=0.011) after 4 weeks. There was also a significant decrease in ICSI, ICPI, PUF, and GUPI symptom scores, daily number of voids, and mean nocturia score (Table 1, p<0.05). Patients also experienced significant increases in the SF-36 quality of life energy/fatigue, social function, and pain scores (P<0.05). At 8-week post-therapy, the positive effects were somewhat attenuated, yet 3/7 patients (42.9%) continued to have significant pain reduction (p=0.047). Mean NRS, ICSI, and PUF scores remained significantly lower (p<0.05), and the SF-36 energy/fatigue remained significantly elevated while emotional well-being and general health scores (unchanged at 4 weeks) had increased significantly from baseline (p<0.05). No adverse events were reported. CONCLUSIONS: This proof-of-concept interventional trial found significant pain reduction, decreases in subjective symptom scores, and increases in quality-of-life scores for nearly all patients. Many benefits persisted for 8 weeks post-therapy. Randomized, sham-controlled trials are necessary to validate these findings. Source of Funding: N/a © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e297 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dylan T. Wolff More articles by this author Peyton Lee More articles by this author Christina Ross More articles by this author Robert J. Evans More articles by this author Gopal Badlani More articles by this author Tyler Overholt More articles by this author Raymond Xu More articles by this author Catherine A. Matthews More articles by this author Stephen J. Walker More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP49-07 AUTONOMIC SYMPTOM SCORE IS GREATER IN INTERSTITIAL CYSTITIS PATIENTS EXHIBITING A NON-BLADDER-CENTRIC PHENOTYPE

You have accessJournal of UrologyCME1 May 2022MP49-07 AUTONOMIC SYMPTOM SCORE IS GREATER IN INTERSTITIAL CYSTITIS PATIENTS EXHIBITING A NON-BLADDER-CENTRIC PHENOTYPE Dylan T. Wolff, Peyton Lee, Robert J. Evans, Gopal Badlani, Catherine A. Matthews, and Stephen J. Walker Dylan T. WolffDylan T. Wolff More articles by this author , Peyton LeePeyton Lee More articles by this author , Robert J. EvansRobert J. Evans More articles by this author , Gopal BadlaniGopal Badlani More articles by this author , Catherine A. MatthewsCatherine A. Matthews More articles by this author , and Stephen J. WalkerStephen J. Walker More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002624.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Symptoms of autonomic system dysfunction may be more common in patients with interstitial cystitis/bladder pain syndrome (IC/BPS). The purpose of this study was to examine the association between autonomic symptom severity and co-occurring symptoms/syndromes in a cohort of IC/BPS patients. METHODS: The Composite Autonomic Symptom Score (COMPASS-31) questionnaire, a validated self-assessment instrument for autonomic symptoms and function, was administered to 86 patients diagnosed with IC/BPS. All the patients have undergone therapeutic hydrodistension (HOD). Data collected include anesthetic bladder capacity (BC), Hunner’s lesion (HL) status, results for validated IC/BPS symptom questionnaires including pain and urgency/frequency symptom scale (PUF) and O’Leary Sant Interstitial Cystitis Symptom and Problem Indices (ICSI/ICPI), and a ‘yes/no’ answer for comorbid non-urologic associated syndromes (NUAS) known to co-occur with IC/BPS. The median COMPASS-31 score (scale of 0-100; higher scores show more severe dysautonomia) was 34.5, therefore patients were divided into two groups: (1) those with COMPASS score >34.5 (N=43), and (2) those with a score <34.5 (N=43). Clinical data were compared to autonomic symptom severity using Fisher’s Exact (categorical) and Wilcoxon Rank Sum (continuous) tests. RESULTS: Patients with more severe dysautonomia (COMPASS-31 score >34.5) were younger (47.95 vs 55.28; p=0.035), more likely to be female (95.3% vs 79.1%; p=0.049), less likely to have Hunner’s lesions (4.7% vs 19%; p=0.049), had a higher PUF score (25.89 vs 21.82; p=0.001), and had a higher number of NUAS (5.39 vs 3.05; p<0.001). These included a significantly higher incidence of pelvic floor dysfunction (52.6% vs 26.2%; p=0.022), fibromyalgia (52.6% vs 16.7%; p<0.001), chronic fatigue syndrome (26.3% vs 7.1%; p=0.032), migraines (50% vs 26.2%; p=0.038), and allergies (65.8% vs 42.9%; p=0.046). Additionally, both endometriosis and chronic pelvic pain approached, but did not reach significance (39.5% vs 21.4%; p=0.092 and 50% vs 28.6%; p=0.067, respectively). CONCLUSIONS: A COMPASS-31 score >34.5 (i.e., higher degree of autonomic symptom severity) was found to correlate with a non-bladder centric phenotype (e.g., HL-, multiple comorbidities) in patients with IC/BPS. Source of Funding: 1R01DK124599-01, R21DK106554-01 © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e855 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dylan T. Wolff More articles by this author Peyton Lee More articles by this author Robert J. Evans More articles by this author Gopal Badlani More articles by this author Catherine A. Matthews More articles by this author Stephen J. Walker More articles by this author Expand All Advertisement PDF DownloadLoading ...

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 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.

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

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

Voiding Function and Dysfunction, Bladder Physiology and Pharmacology, and Female Urology.

Voiding Function and Dysfunction, Bladder Physiology and Pharmacology, and Female Urology.

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 Comparison of intravesical hyaluronic acid and other modalities for the improvement of interstitial cystitis symptoms: a systematic reviews and meta-analysis

Background: Interstitial cystitis (IC) is a chronic inflammation of the bladder which causes unpleasant sensations. This condition considerably reduces patients' quality of life. Intravesical hyaluronic acid is one of the new interventions for interstitial cystitis management, in which a thorough review and meta-analysis regarding this topic are still limited. This study aimed to compare the efficacy of intravesical hyaluronic acid with other intravesical treatment modalities available to treat interstitial cystitis.Method: Systematic literature searching with the main keywords of "interstitial cystitis" or "bladder pain syndrome" and "intravesical hyaluronic acid" was conducted. The main outcome of this study was pain assessment using a visual analogue scale (VAS) and Interstitial Cystitis Symptoms Index (ICSI), and problem index (ICPI). Meta-analysis was carried out when comparative studies were available. Eleven studies were obtained to assess intravesical hyaluronic acid's effects, including three in the meta-analysis. The intravesical treatments found as a comparison were heparin and chondroitin sulphate.Result: There was significant heterogeneity among studies included in all parameters. The pooled analysis showed no significant difference in VAS reduction, improvement of ICSI and ICPI score (p = 0.11, p = 0.35, and p = 0.28, respectively) between hyaluronic acid and other intravesical treatments.Conclusion: There was no significant difference between hyaluronic acid and other intravesical treatments. However, further research with a larger sample is needed to confirm the best modalities in interstitial cystitis.

Anti-inflammatory iron chelator, DIBI, reduces leukocyte-endothelial adhesion and clinical symptoms of LPS-induced interstitial cystitis in mice.

Interstitial cystitis (IC) is a prevalent and debilitating chronic inflammatory disease of the urinary bladder. Currently there are no fully effective therapeutic agents available, in part due to the still obscure pathogenesis of IC. Lipopolysaccharide (LPS) also known as endotoxin from Gram negative bacteria elicits IC in mice and has formed the basis of model systems for investigation. Excess free iron plays an important role in inflammation through generation of reactive oxygen species (ROS). The novel iron chelator DIBI has been shown to sequester excess free iron and dampen excess inflammatory responses to systemic LPS administration and also to Gram negative bacterial infections. The overall objective of this study was to evaluate the effects of DIBI on LPS induced IC in mice. Leukocyte activation, endothelial adhesion and functional capillary density were assessed by intravital microscopy of the bladder microcirculation following a single intravesical LPS administration with or without intravesical DIBI treatment. Clinical IC symptoms were also assessed through behavioral and pain threshold force measurements. Four groups of female BALB/c mice (n = 5-6/group) were randomized in this study: control group, IC group without therapy, IC group with DIBI therapy and control group with DIBI therapy. The groups were examined using intravital microscopy (IVM) of the bladder for leukocyte-endothelial interactions (adherent leukocytes, temporarily interacting leukocytes) and functional capillary density (FCD). A modified behavioral score by Boucher et al. and Von-Frey-Aesthesiometry were used to evaluate key behavioral indices related to pain and visceral pain perception. LPS introduced intravesically induced an early (≤2h) inflammation of the bladder evidenced by leukocyte activation and adhesion to bladder capillary walls. Intravesical DIBI therapy of mice 30min following LPS administration and assessed after 1.5h treatment showed a significant decrease in the number of adherent leukocytes compared to IC animals without DIBI treatment. DIBI treated mice showed a significantly lowered increase in behavioral distress scores compared to IC mice without therapy. Untreated IC mice exhibited a significantly decreased threshold force value for evoked pain response and DIBI treatment improved the threshold pain response. A significant inverse correlation was found for the two pain and suffering evaluation methods results. DIBI reduced inflammatory endothelial leukocyte adhesion and key indices related to pain and suffering over those observed in untreated IC mice. Our findings suggest a potential therapeutic role for DIBI for IC treatment.

Chondroitin Sulfate and Hyaluronic Acid Perfusion for Interstitial Cystitis/Bladder Pain Syndrome: A Systematic Review and Meta-Analysis

Currently, no suitable delivery methods are available for the drugs to interstitial cystitis/ bladder pain syndrome (IC/BPS). Herein we systematically evaluated the therapeutic effects of intravesical infusion of hyaluronic acid (HA) and chondroitin sulfate (CS) in patients with IC/BPS. This study includes randomized controlled trials (RCT) and self-controlled studies of IC/BPS patients treated with HA, CS, or both. English databases like PubMed, Cochrane Library, Embase, and Medline were searched until up to January 31, 2021. Information was extracted based on the inclusion and exclusion criteria, and then meta-analysis was performed. Sixteen studies including 491 patients were included and analyzed. The responsive rate of treatment was 91.24%. In 3 RCTs, the analogue scale (VAS) for pain on fix-effect model was [mean difference, MD -0.57 (95%CI, -1.55, -0.41)]. A significant improvement on random-effect model was [MD -2.78 (95%CI, -3.48, -2.07)] in 13 self-controlled studies. Outcomes on O’Leary-Sant Interstitial Cystitis Symptom Index, Problem Index, frequency, urgency, and bladder capacity were also significantly improved. Subgroup analysis showed significant difference between HA, CS, and the combination, and the perfusion of HA was more effective (Z = 29.97, P &lt; 0.01). Also, different follow-up times after last treatment showed significant difference (Z = 7.69, P &lt; 0.01). It can be beneficial for IC/BPS patients who have not responded to conventional treatments.

Local immune response in patients with classic and nonulcer type of interstitial cystitis/bladder pain syndrome

Several hypotheses regarding the pathophysiology of interstitial cystitis/bladder pain syndrome (IC/BPS) have been put forward, but no consensus has yet been reached. It is suggested that cytokines are involved in IC/BPS, as well as in inflammatory autoimmune diseases. Examining various biomarkers of bladder tissue, including mast cells is underway. However, few reports on a consistent immune activity profile are available. The aim of the study was to assess the cytokine profile, counts of mast cells and plasma cells as well as their relationship in patients with IC/BPS with and without Hunner’s lesions. 44 women with Hunner’s lesions (group I) and 82 women with non-ulcer type (group II) were examined. Patients were questioned on the Pelvic Pain Symptom Scale, Urinary Frequency Scale (PUF), Visual Analogue Scale (VAS) and O’Leary–Santa Interstitial Cystitis Symptom Index (ICSI). Cystoscopy and hydrodistension of the bladder were performed under general anesthesia. In biopsies of the bladder wall, the number of plasma cells and mast cells was assessed, in urine — IL-1β, IL-6, IL-8, TNFα. Statistical processing of the results was carried out using the Statistica 6 software (StatSoft, USA). The Student’s t-test, Spearman’s correlation coefficient were calculated. In patients with Hunner's ulcer, there was an insignificant increase in the scale indices and decreased magnitude for average volume, urination frequency, and maximum emptying volume. The maximum bladder capacity during hydrodistension was lowered by 42.01% (p 0.001). The level of IL-8 in group I was higher on average by 28.57% (p = 0.434) as compared with that in group II, IL-6 — by 13.46% (p = 0.638), TNFα — by 9.09% (p = 0.244) and IL-1β — by 4.13% (p = 0.859). The number of mast cells in patients of group I vs. group II was higher by 40.65% (p 0.05). In group I, a marked relationship was found between count of mast cells and plasma cells (r = –0.555, p 0.05), as well as between count of plasma cells and IL-6 level (r = –0.639, p 0.05). In group II, a significant connection was found between count of mast cells and TNFα level (r = +0.562, p 0.05). Patients with Hunner’s IC/BPS are characterized by severe inflammation, wherein mast cells are involved in induction. Determination of cytokines in urine can provide a non-invasive division of IC/BPS into ulcerative and non-ulcerative groups.

B6 Mouse Strain: The Best Fit for LPS-Induced Interstitial Cystitis Model.

Interstitial cystitis (IC) is a chronic inflammatory disease characterized by bladder pain and increased urinary frequency. Although the C57BL/6J (B6) and FVB/NJ (FVB) mouse strains are commonly used as animal models for studies involving the urinary system, few reports have compared their lower urinary tract anatomy, despite the importance of such data. Our study aimed to characterize bladder function changes in FVB and B6 mouse strains with lipopolysaccharide (LPS)-induced IC, to understand mouse model-based bladder research. The bladder function parameters were measured by cystometrogram. Histological assay was examined by hematoxylin and eosin stain, Masson’s trichrome stain, and immunofluorescence staining. Results indicated that the two strains in the control group exhibited different bladder structures and functions, with significant anatomical differences, including a larger bladder size in the FVB than in the B6 strain. Furthermore, cystometry tests revealed differences in bladder function pressure. LPS-treated B6 mice presented significant changes in peak pressure, with decreased intercontraction intervals; these results were similar to symptoms of IC in humans. Each strain displayed distinct characteristics, emphasizing the care required in choosing the appropriate strain for bladder-model studies. The results suggested that the B6 mouse strain is more suitable for IC models.

How do women with interstitial cystitis/bladder pain syndrome make treatment choices?

Introduction and hypothesisThere is a relative lack of data regarding how patients weigh various factors when choosing a treatment strategy for interstitial cystitis/bladder pain syndrome (IC/BPS). Our aim is to describe patient experience with their current and prior treatments and discuss factors they consider when choosing a treatment.MethodsTwenty-one women with IC/BPS participated in five focus groups moderated by a psychologist. Focus groups were conducted until thematic saturation was reached. Group discussions were transcribed and independently coded by two reviewers. Emergent themes and concepts were identified using grounded theory methodology. Data on symptoms and beliefs regarding medications were collected using validated questionnaires: Interstitial Cystitis Symptom and Problem Index (ICSI and ICPI) and Beliefs in Medications Questionnaire-Specific (BMQ-S).ResultsThe median age of participants was 42 years, and all had some college education. Median score (range) for the ICSI was 12 (4, 20) and for the ICPI was 10 (3, 16), indicating moderate symptom burden. Most patients had tried only first- or second-line treatments. The median BMQ-S score was 2, indicating a neutral attitude toward medication. Several themes were identified. Patients expressed interest in self-management of symptoms using a structured care plan that incorporates guided self-care practices and care that can be delivered virtually. Patients desired to minimize treatment side effects by reducing prescription medications and avoiding surgical procedures. Finally, patients had considerable interest in alternative treatments; however, they wanted these treatments to be evidence-based.ConclusionsWomen with IC/BPS have a strong interest in guided programs that teach self-care practices and deliver alternative treatments through remote platforms.

Evidence for Early Cyclosporine Treatment for Hunner Lesion Interstitial Cystitis.

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

Interstitial cystitis symptoms as defined are indistinguishable from posterior fornix syndrome symptoms cured by uterosacral ligament repair

Interstitial cystitis symptoms as defined are indistinguishable from posterior fornix syndrome symptoms cured by uterosacral ligament repair

Оценка сексуальной функции женщин с первичным синдромом болезненного мочевого пузыря

Introduction. Primary bladder pain syndrome (PBPS) also known as interstitial cystitis/bladder pain syndrome is a disease with a significant deterioration in quality of life. The reason of that is not only the presence of constant pain in the bladder and urinary disorders, but also due to psychoemotional disorders and sexual dysfunctions. The aim of the study was to assess the prevalence, nature and severity of sexual dysfunctions in women with PBPS. Materials and methods. The study involved 75 women (mean age 42.4±3.1 years) with a confirmed diagnosis of PBPS, the control group consisted of 75 women (mean age 41.8 ± 2.9 years) without dysuria and pelvic pain. The severity of clinical manifestations of PBPS was assessed on the basis of a 10-point visual analogue scale of pain in the bladder (VAS-10), questionnaires «Pelvic Pain and Urgency/Frequency Patient Symptom Scale, PUF Scale» and O'Leary-Sant Interstitial Cystitis Symptoms Index (ICSI). Sexual function was assessed using a specialized questionnaire «Female Sexual Function Index» (FSFI). Results. The overall assessment of sexual function according to the FSFI questionnaire in patients with PBPS was significantly lower than in the control group. In the patients of the main group the mean score according to the FSFI questionnaire was 16.5 ± 4.4, while in the control group it was 30.5 ± 4.2 points (p &lt;0.01). Sexual dysfunctions were detected in 69 (92%) of 75 patients with PBPS and in 24 (32%) women in the control group. The most common type of dysfunction was dyspareunia, which was reported by 72% of women with PBPS. For all components of the sexual function of women with PBPS, its deterioration was noted in older age groups. The degree of sexual dysfunction significantly correlated with the intensity of PBPS symptoms. Discussion. Our results confirm a significant deterioration in sexual function in women with PBPS, which coincides with the data of other authors. The most common disorder is pain during intercourse. The symptoms of PBPS leads to the development of various sexual dysfunctions. It is advisable at the diagnostic stage for all women with chronic pelvic pain to assess their sexual function to understand the presence and severity of sexual dysfunctions. Conclusions. The results of this study indicate a high prevalence of sexual dysfunction in women with PBPS. The presence of pain during intercourse is the most frequent clinical manifestation and causes the development of other sexual disorders: desire, arousal, lubrication, orgasm and satisfaction. The high frequency of sexual dysfunctions and a significant impact on the quality of life of women with PBPS indicates the need for additional therapeutic measures to restore sexual function.

A Novel Use of Cyclobenzaprine and Hyoscyamine (BLAVACARE TM) Impregnated Vaginal Suppositories for the Symptomatic Treatment of Interstitial Cystitis, Bladder Spasms, and Painful Bladder Syndrome

Interstitial Cystitis and Painful Bladder Syndrome are chronic conditions that are associated with urinary frequency, urgency, pain, and nocturia. The etiology of IC/PBS is not clearly understood, therefore diagnosis and treatment can be challenging. IC/PBS greatly affects the quality of life in several ways. In this report, we present the case of a patient with longstanding interstitial cystitis symptoms who was successfully treated with a novel approach after failing treatment established by the current guidelines in the management of IC/PBS. This case illustrates the complex nature of this syndrome and offers a new treatment approach that can potentially change the way IC/PBS are medically managed.

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.