Pelvic Pain And Urgency/Frequency Research Articles

Symptomatic Autonomic Dysfunction in Interstitial Cystitis/Bladder Pain Syndrome.

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a highly prevalent condition with incompletely understood pathophysiology, especially in relation to the systemic symptoms experienced. The role of autonomic nervous system dysfunction in IC/BPS remains poorly understood. The purpose of this study was to assess the relationship between autonomic symptom severity and clinical characteristics of patients with IC/BPS. This is a retrospective cohort study of 122 IC/BPS patients who completed the Composite Autonomic Symptoms Score (COMPASS-31) questionnaire. Data were collected on anesthetic bladder capacity (BC), Hunner lesion (HL) status, results for validated IC/BPS symptom questionnaires (O'Leary Sant Interstitial Cystitis Symptom Index and Interstitial Cystitis Problem Index (ICSI/ICPI) and the Pelvic Pain and Urgency/Frequency (PUF) scale), and comorbid nonurologic associated syndromes. Using the first quartile of COMPASS-31 scores as the cutoff, we compared patients within the first quartile (low symptom load; n = 30), to the remainder of the patients (high symptom load; n = 92). Patients scoring ≥20.36 were significantly less likely to be HL positive (10.9% vs 26.7%; P = 0.043) and had a significantly higher BC (823.10 ± 396.07 vs 635.00 ± 335.06; P = 0.027), higher scores on the PUF questionnaire (23.80 ± 4.98 vs; 19.61 ± 5.22 P < 0.001), and a higher number of nonurologic associated syndromes (5.65 ± 2.90 vs 2.60 ± 1.89; P < 0.001). Patients with IC/BPS experience widespread symptoms associated with autonomic nervous system dysfunction. A higher symptom load strongly correlates with a nonbladder-centric phenotype. These findings provide further evidence that total body nervous system dysfunction is present in patients with nonbladder centric IC/BPS.

The potential mechanism of treating IC/BPS with hyperbaric oxygen by reducing vascular endothelial growth inhibitor and hypoxia-inducible factor-1α.

To investigate the roles of vascular endothelial growth inhibitor (VEGI) and hypoxia-inducible factor-1α (HIF-1α) in the treatment of refractory interstitial cystitis/bladder pain syndrome (IC/BPS) with hyperbaric oxygen (HBO). A total of 38 patients were included. They were assessed before and 6 months after HBO treatment. Three-day voiding diaries were recorded, and O'leary-Sant scores, visual analog scale (VAS) scores, quality of life (QoL) scores, pelvic pain, and urgency/frequency (PUF) scores were evaluated. Bladder capacity was assessed by cystoscopy. Bladder mucosa was collected for Western blot, qRT-PCR, and immunofluorescence staining to compare the expression of VEGI and HIF-1α before and after treatment. Compared with before treatment, patients showed significant improvements in 24-h voiding frequency (15.32 ± 5.38 times), nocturia (3.71 ± 1.80 times), O'leary-Sant score (20.45 ± 5.62 points), VAS score (41.76 ± 17.88 points), QoL score (3.03 ± 1.44 points), and PUF score (19.95 ± 6.46 points) after treatment (p < 0.05). There was no significant difference in bladder capacity before and after treatment (p ≥ 0.05). The expression levels of VEGI and HIF-1α protein and mRNA were significantly decreased 6 months after treatment compared with before treatment. Immunofluorescence staining results showed that the double positive expression of VEGI and HIF-1α protein in bladder tissue of IC/BPS patients after HBO treatment quantitatively decreased significantly. This study identified a possible mechanism by which VEGI and HIF-1α expression decreased after HBO treatment due to hypoxia reversal, which improved symptoms in IC/BPS patients.

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.

Novel Treatment for Interstitial Cystitis Pilot Study

Background and aims: Use of platelet-rich plasma (PRP) is well established in treatment of orthopedic patients. This pilot study aims to determine the efficacy of using instillation of PRP paired with hydrodistention of the bladder to treat patients with interstitial cystitis (IC). Methods: Patients with a diagnosis of interstitial cystitis were recruited to this study. Patients completed Pelvic Pain and Urgency/Frequency (PUF) patient symptom scale, which quantified a symptom and bother score. Patients were treated with hydrodistention with instillation of PRP. Patients completed the PUF questionnaire weekly for six weeks following treatment. Results: 12 patients underwent hydrodistention with instillation of PRP. The patients were all women, ranging in age from 23 to 71. The mean symptom score went from 13.167 to 7.417 and the mean bother score decreased from 6.833 to 4.41, showing a statistically significant reduction in symptom and bother scores. Conclusions: Hydrodistention with instillation of PRP is an effective treatment of interstitial cystitis.

Comparison of bladder autoaugmentation by transurethral vesicomyotomy and hydrodistention for ketamine cystitis

BackgroundTo illustrate the bladder autoaugmentation by transurethral vesicomyotomy (BATV) and compare the efficacy and safety of BATV to bladder hydrodistention (BH) for managing ketamine cystitis (KC).MethodsWe retrospectively analyzed clinical data for 53 patients with KC who received surgical intervention between 2014 and 2019 at our hospital. Of these, 41 (77.4%) underwent BH and 12 (22.6%) were subjected to BATV, with a minimum of 1-year follow-up. These groups were compared with reference to urodynamic parameters, subjective symptom scores as well as all complications.ResultsBoth groups were matched in age, addiction time, preoperative urodynamic parameters, postvoid residual urinary volume (PVR), and symptom scores. All urodynamic parameters including maximum cystometric capacity (MCC), maximum detrusor pressure (Pdet max), compliance, maximum urinary flow rate (Qmax) and symptom scores had improved significantly in two groups whether at 3 or 12 months. Moreover, the MCC was significantly increased after BATV than BH, at a mean [standard deviation (SD)] of 281.0 (25.7) vs. 213.5 (35.6) mL (P<0.001) at 12-month follow-up. The Qmax and the Pelvic Pain and Urgency/Frequency (PUF) symptom score were still noted better in the BATV group at 3 months after surgery. Additionally, patients in both groups had similarly low rates of complications.ConclusionsBATV is superior to BH with increased bladder capacity and urodynamic outcomes, although showing equivalent in symptom relief and a similar rate of complications.

Prevalence of Bladder Pain Syndrome-like Symptoms: a Population-based Study in Korea.

ObjectivesTo investigate the prevalence of bladder pain syndrome (BPS)-like symptoms in the general population of South Korea.MethodsBetween April 16, 2016 and April 29, 2016, we conducted an online survey and computer-assisted personal interviews with adults aged 40–79 years in Korea using structured questionnaires. The sample size was 3,000 (95% confidence level standard error ± 1.79%), and the sampling method was simple randomization according to sex, age, and residential area in proportion to the resident registration demographics of the Korean Ministry of Interior and Safety as of March 2016. All participants were surveyed using the Korean version of the Pelvic Pain and Urgency/Frequency (PUF) Patient Symptom Scale and Geriatric Depression Scale (GDS). The primary outcome was the prevalence of BPS-like symptoms, defined as a total PUF score of ≥ 12.ResultsOverall, the prevalence of BPS-like symptoms was 16.4% (483 of 3,000 participants). Women (21.4%) had a significantly higher prevalence of BPS-like symptoms than men (10.7%) (P < 0.01). The prevalence by age was significantly higher in the 70s group than in the other age groups (P < 0.01), and increased significantly with the increasing severity of depression on the GDS (P < 0.01). The prevalence of BPS-like symptoms according to the marital status was significantly different, that is, the prevalence among divorced/bereaved individuals was higher than those of married or unmarried individuals (P < 0.01).ConclusionOur large, representative population-based study showed that BPS-like symptoms are widespread among the general population of South Korea. BPS is considered a disease that deserves greater attention as it is far more common than previously thought and can negatively affect many people's quality of life.

Efficacy of cystectasia in the treatment of ketamine-induced bladder contracture.

BackgroundThe treatment of ketamine-induced bladder contractures remains poorly studied. We therefore evaluated the efficacy of cystectasia with a sodium hyaluronate balanced solution in this kind of bladder contracture.MethodsEighteen patients presenting with ketamine-induced bladder contracture between July 2010 and February 2018 were selected and analysed. Ketamine was discontinued in all patients, who were then treated with weekly cystectasia (0.09% sodium hyaluronate balanced solution) 3 times. The volume of the first perfusion was twice the preoperatively measured bladder capacity, and the volume of the subsequent two perfusions was increased by 100 mL each time. The Pelvic Pain and Urgency/Frequency (PUF) symptom score, O’Leary-Sant Interstitial Cystitis (IC) Symptom Index (ICSI), IC Problem Index (ICPI), Quality of Life (QOL) score, and bladder capacity were recorded before surgery and 3 and 12 months after the 3rd expansion.ResultsNo significant complications were observed during the 3 expansions. Fourteen patients completed the full follow-up schedule. Preoperatively and at the 3- and 12-month follow-up evaluations performed after the 3rd expansion, the PUF symptom scores were 20.4±3.6, 11.5±3.1, and 13.2±3.3, respectively; the mean ICSI was 13.6±2.8, 7.7±2.3, and 8.2±2.5, respectively; the mean ICPI was 10.6±2.6, 7.3±2.1, and 7.7±2.5, respectively; and the mean QOL scores were 6.0±0, 2.1±0.5, and 2.7±0.8, respectively; and the mean bladder catheter volume was 83±27, 234±56, and 228±52 mL, respectively. There were significant differences between all preoperative and postoperative values.ConclusionsCystectasia with a sodium hyaluronate balanced solution is an effective treatment modality for ketamine-induced bladder contracture.

Bladder neck stenosis surgery in interstitial cystitis / bladder pain syndrome treatment

Introduction. Current methods of interstitial cystitis / bladder pain syndrome (IC/BPS) treatment dont allow to achieve long-term clinical remission.&#x0D; Aim of the study was to investigate the clinical efficacy of bladder neck transurethral incision (TUI) in women with IC/BPS, who had bladder outlet obstruction signs.&#x0D; Materials and methods. TUI was performed to patients with IC/BPS and proven bladder neck stenosis (n = 29). Assessment of the results of this operation was provided after 1, 3 and 6 months after surgical treatment. Treatment efficacy was evaluated by using Global Response Assessment (GRA) Scale, Pelvic Pain and Urgency / Frequency (PUF) Patient Symptom Scale, urination diaries, analysis of which allowed to determine functional bladder capacity, urinary frequency and nocturia. Pain assessment was made with 10-point Visual Analogue Pain Scale (VAS). Functional efficacy was evaluated with urodynamic examination, which included cystometric bladder capacity, maximal urinary flow rate and residual volume rate. Treatment results were compared with such in 39 patients with IC/BPS without signs of bladder neck stenosis.&#x0D; Results. GRA score 2 had 96.5% and 72.4% in 1 and 3 months after bladder neck TUI, respectively. VAS, PUF Scale parameters, cystometric bladder capacity, maximal urinary flow rate, residual volume rate, urinary frequency and nocturia values also significantly improved after surgery.&#x0D; Conclusions. This prospective clinical study is the first, in which IC/BPS course in women with bladder neck stenosis was investigated. It was noticed, that in 1 month after bladder TUI in 96.5% of patients decreased severity of IC/BPS symptoms, there were no urinary tract infection and local complications. In addition, this effect lasted for 3 months after surgery in 72.4% of patients and for 6 months in 68.9% of patients.

V11-11 ROBOTIC AUGMENTATION CYSTOPLASTY FOR CONTRACTED BLADDER SECONDARY TO CYSTITIS: A 1-YEAR OUTCOME ASSESSMENT

You have accessJournal of UrologyTransplant, Misc GU Cancers & Bladder Reconstruction (non-cancer) (V11)1 Apr 2020V11-11 ROBOTIC AUGMENTATION CYSTOPLASTY FOR CONTRACTED BLADDER SECONDARY TO CYSTITIS: A 1-YEAR OUTCOME ASSESSMENT Chi Hang Yee*, Peter Ka Fun Chiu, Yun Sang Chan, Jeremy Yuen Chun Teoh, Mandy Ho Man Tam, Hon Ming Wong, Chi Kwok Chan, See Ming Hou, and Chi Fai Ng Chi Hang Yee*Chi Hang Yee* More articles by this author , Peter Ka Fun ChiuPeter Ka Fun Chiu More articles by this author , Yun Sang ChanYun Sang Chan More articles by this author , Jeremy Yuen Chun TeohJeremy Yuen Chun Teoh More articles by this author , Mandy Ho Man TamMandy Ho Man Tam More articles by this author , Hon Ming WongHon Ming Wong More articles by this author , Chi Kwok ChanChi Kwok Chan More articles by this author , See Ming HouSee Ming Hou More articles by this author , and Chi Fai NgChi Fai Ng More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000945.011AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ketamine abuse can result in a small contracted bladder via a pathological inflammatory and fibrotic process. We reported the 1-year outcome of robotic augmentation cystoplasty in patients diagnosed of ketamine cystitis. METHODS: This is a prospective series of patients with ketamine cystitis who underwent robotic augmentation cystoplasty in our institution. During the surgery, 30-35cm ileal segment was isolated for augmentation in a clamp cystoplasty manner. Assessment included basic demographic data, functional bladder capacity (FBC), pelvic pain and urgency/frequency (PUF) symptom scale, EQ-VAS and analgesic consumption. Pre-operative and 1-year follow-up data were compared. RESULTS: Between October 2014 and July 2018, 11 patients underwent the procedure. Mean operative time was 283.8 ±98.9 minutes. Pre-operative mean FBC was 58.1 ± 36.6, 1-year post-operative FBC was 309.3 ± 231.5ml (p=0.001). Improvement in PUF total score (mean score 27.0 ± 4.1 vs 15.6 ± 6.1, p=0.003) and decrease in analgesic consumption (number of patients 6 vs 1, p=0.037) were observed after operation. One patient had Clavien-Dindo grade 1 complication and one patient had Clavien-Dindo grade 3 complication. CONCLUSIONS: Robotic augmentation cystoplasty provides a minimally invasive surgical option to significantly improve the bladder capacity in patients with a contracted bladder. Pain relief can also be achieved in severe cystitis patient after robotic augmentation ileocystoplasty. Source of Funding: Nil © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1017-e1018 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chi Hang Yee* More articles by this author Peter Ka Fun Chiu More articles by this author Yun Sang Chan More articles by this author Jeremy Yuen Chun Teoh More articles by this author Mandy Ho Man Tam More articles by this author Hon Ming Wong More articles by this author Chi Kwok Chan More articles by this author See Ming Hou More articles by this author Chi Fai Ng More articles by this author Expand All Advertisement PDF downloadLoading ...

Comparison of the Efficacy Between Transurethral Coagulation and Transurethral Resection of Hunner Lesion in Interstitial Cystitis/Bladder Pain Syndrome Patients: A Prospective Randomized Controlled Trial

BackgroundInterstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic condition characterized by chronic pelvic pain related to the bladder with no effective treatment options. ObjectiveTo evaluate the efficacy and safety of transurethral resection (TUR) and transurethral coagulation (TUC) as treatments for Hunner lesion (HL) in IC/BPS. Design, setting, and participantsA single-center, prospective, randomized controlled trial involving 126 patients with HL in IC/BPS. InterventionTUR or TUC. Outcome measurements and statistical analysisPrimary outcome was recurrence-free time after surgery. Secondary outcomes included change of the number of frequency, nocturia, urgency episodes in voiding diaries, O’Leary-Sant Interstitial Cystitis Symptom Index (ICSI) and Interstitial Cystitis Problem Index (ICPI), pelvic pain and urgency/frequency (PUF) symptom scale, and visual analog scale (VAS) for pain and risk factors for recurrence. Results and limitationsThere were no differences in the recurrence-free time between treatment groups, a difference of 12.2 mo (95% confidence interval [CI], 11.1–17.6) for TUR, and a difference of 11.5 mo (95% CI, 9.03–16.1; p=0.735) for TUC. No difference was found in decreased mean daytime frequency, nocturia, urgency episodes, ICSI, ICPI, PUF symptom scale, and VAS for pain between both groups over 12 mo. Regardless of treatment types, there were significant improvements in all symptom questionnaires and pain compared with baseline (all, p < 0.05). Treatment type (TUR or TUC), age, sex, previous history of hydrodistension, and number of HLs did not affect recurrence. Incidence of bladder injury was higher in the TUR group (7.9%) than in the TUC group (3.4%). ConclusionsThere was no difference in the recurrence-free time and effect on urinary symptoms, including pain between TUC and TUR, for HL. Taking into account procedure-related complications, the surgeon can choose the method with which he/she is most familiar and comfortable. Patient summaryIn patients with bladder pain syndrome with Hunner lesions, both endoscopic resection and coagulation of the lesions are effective treatments.

Sexual dysfunction in women with interstitial cystitis/bladder pain syndrome: A case-control study.

Introduction:Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic debilitating illness characterized by urinary frequency, urgency, and pelvic pain. IC/BPS adversely affects the sexual well-being of the patients. We used the Female Sexual Function Index (FSFI) to compare sexual dysfunction (FSD) in women with IC/BPS versus controls in an Indian cohort where such data is lacking.Materials and Methods:This case–control study was designed to compare the FSDs in patients with IC/BPS to that of asymptomatic controls. Pelvic Pain and Urgency/Frequency (PUF) Questionnaire scores and FSFI scores were used as tools for this study.Results:Thirty-two patients were recruited in each group. Patients with IC/BPS had a significantly higher PUF score as compared to the control group (7.843 vs. 3.656). These patients also scored worse on the total adjusted FSFI score (18.678 ± 4.531 vs. 28.05 ± 4.318; P < 0.05) and individually in all domains of sexual function. Twenty-nine (90.62%) patients of the IC/BPS group had FSD as compared to 12 (37.5%) of patients in the control group. Pain was the most common presenting complaint and was seen in 65.25% of patients in the IC/BPS group as compared to only 31.25% of patients in the control group.Conclusion:The results of our study show that women with IC/BPS have more pain and sexual dysfunction than controls.

The association of vulvar pain and urological urgency and frequency: findings from a community-based case-control study.

Vulvodynia is chronic debilitating burning vulvar pain or pain on contact. Although women who suffer from vulvodynia are more likely than others to experience co-morbid interstitial cystitis (IC) and urinary tract infections (UTIs), few studies have explored whether women with vulvodynia experience adverse urinary symptoms (lower urinary tract symptoms [LUTS]) in the absence of urological pain. Two hundred and eleven participants with and 226 participants without clinically confirmed vulvodynia completed the Pelvic Pain and Urgency/Frequency (PUF) questionnaire and were scored using all questions, and then a subset of questions relating only to their current frequency and bother of urination during day and night, and the frequency, severity and bother of urgency after voiding. Total, symptom, and bother scores were compared in women with and without vulvodynia, and regression models estimated adjusted odds ratios and 95% confidence intervals for the various LUTS symptoms. As expected, 40% of women with vulvodynia met the criteria for IC (PUF > 12) compared with 2% without vulvodynia. After excluding questions related to bladder or vulvovaginal pain, women with vulvodynia, compared with those without, were skewed toward higher PUF scores, including being 2.4 times more likely to report usually or always bothered by night-time voiding (95% CI 1.22-4.74), and 18 times more likely to report moderate/severe urgency after urination (95% CI 5.48-64.12). Women with vulvodynia are substantially more likely to report voiding dysfunction and symptoms of urgency than women with no history of vulvar pain. These findings are independent of comorbid interstitial cystitis or history of UTIs.

Anxiety-depressive manifestations and their relationship with somatic symptoms in patients with interstitial cystitis

Інтерстиційний цистит –­­ важлива не тільки медична, але і соціальна проблема, адже може призводити до втрати працездатності, появи невротичних станів, позбавити повноцінного сну, змінити поведінку. Дослідження та оцінювання тривожно-депресивних розладів у пацієнтів з інтерстиційним циститом дасть змогу краще зрозуміти особливості та структуру психічної складової в симптоматиці цієї патології та розробити найбільш адекватну стратегію лікування із залученням фахівця у сфері психічного здоров’я для роботи в парі з урологом. Мета роботи – оцінити тривожно-депресивні прояви та їхній зв’язок із соматичною симптоматикою в пацієнтів з інтерстиційним циститом. Матеріали та методи. Обстежили 44 пацієнти (38 жінок, 6 чоловіків) із діагнозом інтерстиційний цистит/сечоміхуровий больовий синдром. Для оцінювання соматичних проявів і впливу симптомів на якість життя використали опитувальники Genitourinary Pain Index (GUPI), O’Leary-Sant, Pelvic Pain and Urgency/Frequency Patient Symptom Scale (PUF). Для оцінювання психічних проявів використали шкалу депресії Бека, тест Спілбергера. Результати. Виявили, що 5 осіб мали низький ступінь реактивної тривожності, 11 – помірний ступінь, 28 – високу реактивну тривожність; 9 осіб мали низьку особистісну тривожність, 18 – помірну, 17 обстежених – високу особистісну тривожність. Не встановили кореляцію показників реактивної та особистісної тривожності з результатами опитувальника GUPI, шкали PUF, опитувальника O'Leary-Sant. 22 особи мали легкі депресивні прояви, у 22 осіб – відсутні депресивні симптоми. Визначили зворотну кореляцію між ступенем вираженості симптоматики за опитувальником GUPI та ступенем тяжкості депресії (rs = -0,28, p < 0,1). Виявили пряму кореляцію між негативним впливом на якість життя та ступенем тяжкості депресії (rs = +0,253, p < 0,1). Висновки. Інтерстиційний цистит завжди супроводжується тривожно-депресивною симптоматикою, і тривожна симптоматика більш притаманна та виражена, ніж депресивна. Тяжка симптоматика може бути передумовою розвитку тривожно-депресивних розладів у пацієнтів, однак не є прямою причиною їх виникнення. Особистісна тривожність не є фактором ризику для ранньої появи захворювання та подовження його тривалості, як і більш рання чи пізня поява та довша тривалість інтерстиційного циститу не є передумовою посилення реактивної тривожності. Ступінь тяжкості депресії прямо залежить від негативного впливу соматичних симптомів на якість життя. Комплексний підхід із залученням до діагностики та лікування фахівця у сфері психічного здоров’я може суттєво підвищити ефективність терапії інтерстиційного циститу.

Botulinum toxin type A in the treatment of bladder pain syndrome in women: initial results

We present the results of botulinum toxin type A (BT-A) treatment in 49 women (aged 41-65 years) with bladder pain syndrome. Previously, all patients underwent oral and intravesical drug therapy in addition to hydrodistention of the bladder without significant clinical effect. BT-A at a dose of 100 U (20 points at 5 units) was injected into the bladder under general anesthesia. Treatment results were evaluated 3 months after the treatment using specialized questionnaires such as the Pelvic Pain and Urgency/Frequency (PUF) Scale, O’Leary-Sant Symptom Index and Interstitial Cystitis Scale, visual analogue pain scale (VAS), and urinary diaries. Remarkably, the treatment was effective in 46 (93.8%) patients. By the end of the third month after the BT-A injection, the PUF Scale score, the O’Leary-Sant Symptom and Interstitial Cystitis Scale, and VAS reduced by 41.3%, 32%, and 34%, respectively, and urination frequency decreased by 38.5%. Thus, BT-A is an effective method for treating bladder pain syndrome in patients who are refractory to other treatment methods. (For citation: Al-Shukri SH, Kuzmin IV, Slesarevskaya MN, Ignashov YuA. Botulinum toxin type A in the treatment of bladder pain syndrome in women: initial results. Urologicheskie vedomosti. 2018;8(2):5-10. doi: 10.17816/uroved825-10).

The efficacy of intravesical hyaluronic acid instillation in resistant bladder pain syndrome

Purpose: In this study the authors aimed to assess the efficacy of intravesical hyaluronic acid (HA) instillation in patients with resistant painful bladder syndrome (PBS). Materials and Methods: A series of 32 women with PBS received intravescical instillation of HA once-a-week for eight weeks and then once monthly for four months for a total of 12 doses. The authors considered scale (VAS) pain scores ≥ 4 and total scores (symptom and bother scores) ≥ 13 on the pelvic pain and urgency/frequency (PUF) questionnaire. An efficacy of the HA instillation was evaluated by comparing the mean changes in the scores of the VAS and questionnaires from baseline to eight weeks of treatment. Improvement was defined as a ≥ 2 decrease in the VAS. Results: The authors compared the responses at baseline and after treatment: there were 22 patients (63.0%) with positive response rate at week 8, which was maintained until 12 months. Specifically, both VAS and PUF score decreased significantly after treatment. Conclusion: The present results showed that intravesical HA therapy is an effective treatment for patients with PBS who had inadequate response to conservative treatment.

Гидродистензия мочевого пузыря в лечении больных интерстициальным циститом/синдромом болезненного мочевого пузыря

The study comprised 71 women aged 51.6+/-8.3 years with a 5.2+/-2.3 year history of IC/BPS. All patients underwent bladder hydrodistension (BH). Depending on the duration of BH, patients were divided into 4 groups. The distension time in group 1 (n=10), group 2 (n=20), group 3 (n=20) and group 4 (n=21) was 1 min, 2 min, 4 min and 6 min, respectively. The treatment effectiveness was assessed 1 month after BH by subjective assessment of patients, Pelvic Pain and Urgency/Frequency (PUF) Patient Symptom Scale questionnaire, a visual analog pain scale (VAS), and voiding diaries. At one month after BH, positive effect was observed in 32 (45.1%) patients. In groups 1, 2, 3 and 4 the treatment was effective in 20%, 55%, 45% and 47.6% of patients, respectively. Clinical effectiveness of BH with distension time of 1 min was significantly lower than that of 2, 4, and 6 min. At the same time, we did not find significant differences in the effectiveness of this procedure with distension time of 2, 4 and 6 min. The results of this study suggest that BH is an effective treatment in patients suffering from IC/BPS. At the same time, they show that the distension time of 2 min. is optimal from the point of view of clinical effectiveness, since the longer duration of the procedure is excessive, and the shorter time is insufficient.

Childhood bladder and bowel dysfunction predicts irritable bowel syndrome phenotype in adult interstitial cystitis/bladder pain syndrome patients.

Many clinicians have suggested that a history of bladder and bowel dysfunction (BBD) in childhood predisposes to the development of interstitial cystitis/bladder pain syndrome (IC/BPS) or irritable bowel syndrome (IBS) in adulthood. We hypothesized that BBD symptoms in childhood would predict the IBS-associated phenotype in adult IC/BPS patients. Consecutive female patients (n=190) with a diagnosis of IC/BPS were administered a modified form of a clinical BBD questionnaire (BBDQ) to capture childhood BBD-like symptoms, as well as Interstitial Cystitis Symptoms Index (ICSI), Interstitial Cystitis Problem Index (ICPI), Pelvic Pain and Urgency/Frequency (PUF) questionnaires and UPOINT categorization. Patients were stratified to IBS-positive or IBS-negative according to clinical assessment of IBS-like symptoms. The 127 patients (67%) identified with IBS-like symptoms recalled significantly higher BBDQ scores than the 63 patients (33%) who were IBS-negative (2.8 vs. 2.3; p=0.05). The IBS-positive patients also reported a higher number of UPOINT domains than their non-IBS counterparts (3.8 vs. 2.9; p=0.0001), while their PUF total scores were significantly higher (13.6 vs. 12.3; p=0.04). IBS-positive patients more often recalled that in childhood they did not have a daily bowel movement (BM) (p=0.04) and had "to push for a BM" (p=0.009). In childhood, they "urinated only once or twice per day" (p=0.03) and recalled "painful urination" more than those without IBS (p=0.03). There were no significant differences between the groups in answers to the other five questions of the BBDQ. Our symptom recollection survey was able to predict the IBS phenotype of IC/BPS based on a childhood BBDQ. Further prospective studies are needed to further evaluate these novel findings.

Efficacy of an orally administered combination of hyaluronic acid, chondroitin sulfate, curcumin and quercetin for the prevention of recurrent urinary tract infections in postmenopausal women

ObjectiveTo assess whether the orally administered combination of hyaluronic acid (HA), chondroitin sulfate (CS), curcumin and quercetin could be effective in preventing recurrent cystitis in postmenopausal women and whether its efficacy was conditioned by the concurrent use of local estrogen therapy. Study designThis was a prospective evaluation of 145 postmenopausal women consecutively recruited from the database of three different investigators. All women should have mild-to-moderate urogenital atrophy and a history of recurrent urinary tract infections (≥2 episodes within 6 months or ≥3 episodes within 12 months documented by positive urine cultures) during the last year. Patients were assigned to three different therapeutic regimens: the first group was treated only with vaginal estrogens, the second group only with HA, CS, curcumin and quercetin per os, and the third group was treated with HA, CS, curcumin and quercetin associated with local estrogens. We evaluated the number of patients with <2 infective episodes in the 6-month follow-up and <3 episodes in the 12-month follow-up (main aim definition) and the reduction of related symptoms through a Visual Analog Scale (VAS) and the Pelvic Pain and Urgency/Frequency (PUF) patient symptom scale. Student's t-test and chi-squared test were used for data analysis as appropriate. ResultsAt 6-month follow up, the main aim rate was 8%, 11.1% and 25% in the three groups, respectively (p<0.05 compared to baseline only in group 3). Although the reduction in the number of recurrent episodes became significant in all groups at 1 year follow-up, the main aim rate was almost double in women receiving both local estrogens and oral therapy (group 3) compared to those receiving single treatments. The improvement of related symptoms was significant in all groups at 12-month follow-up. ConclusionsIn postmenopausal women, the combination of HA, CS, curcumin and quercetin per os was effective in preventing recurrent urinary tract infections, especially if administered with vaginal estrogen therapy.

Clinical staging of ketamine-associated urinary dysfunction: a strategy for assessment and treatment.

To describe a clinical staging method linked to stepwise treatment indications for ketamine-associated urinary dysfunction (KAUD) based on review of our experience in management of KAUD patients and analysis of their clinical features. The eighty-one KAUD patients hospitalized from January 2008 to June 2014 were studied retrospectively. According to ketamine history, renal and liver function, bladder change and up urinary tract involvement, patients were categorized into a described model of three stages. Discriminant analysis was applied to validate the model. The void volume, micturition interval, nocturnal void frequency and pelvic pain and urgency/frequency (PUF) questionnaire score were, respectively, compared after treatments. There were, respectively, 24, 47 and 10 patients in three stages. The duration of abuse varied (p=0.047) correlated with clinical stages (p=0.015, r=0.268). The severity of LUTS was not significant. The creatinine, estimated glomerular filtration rate and liver function were worse in higher stages (p<0.01), and the incidence of ureteral change and hydronephrosis was greater (p<0.001). Based on the model, cross-validation confirmed 83.1% cases were classified correctly. Twenty-four patients in stage I were treated with behavioral modification and pharmacotherapy, thirty-five patients in stage II with hydrodistention and six patients in stage III with surgical intervention due to rapid progression after conservative therapy. All patients in three stages demonstrated improvements in void volume, micturition interval, nocturnal void frequency and PUF score (all p<0.05) after treatment. Clinical staging could serve for assessment of progression, and the staging-based treatment is effective. This model still awaits further validation.

Test-retest reliability and discriminant validity for the Brazilian version of "The Interstitial Cystitis Symptom Index and Problem Index" and "Pelvic Pain and Urgency/Frequency (PUF) Patient Symptom Scale" instruments.

BackgroundThe purpose is to evaluate the psychometric properties of reliability and discriminant validity of the Brazilian Portuguese versions of two instruments used in the diagnosis of interstitial cystitis (IC): “The Interstitial Cystitis Symptom Index and Problem Index” (The O’Leary-Sant), and “Pelvic Pain and Urgency/Frequency (PUF) Patient Symptom Scale”.MethodsThree groups of patients were examined: a study group (subjects with IC), control group 1 (individuals with at least one IC symptom), and control group 2 (subjects without IC symptoms). Test-retest stability was evaluated at intervals of 3 to 7 days in the study group. Discriminant validity was examined in all three groups.ResultsThe intraclass correlation coefficient (ICC) [95% confidence interval (CI)] results were 0.56 (range, 0.21-0.78) for The O’Leary-Sant Symptom Index, 0.48 (range, 0.10-0.73) for The O’Leary-Sant Problem Index, and 0.49 (range, 0.12-0.74) for the PUF. To analyze discriminant validity between groups, we used Fisher’s exact test and odd ratio (OR) to identify differences. We obtained a P value<0.0001, which indicated that the null hypothesis was rejected; in other words, there was evidence that at least two different groups were compared to the proportion of patients with IC.ConclusionsThe analyzed instruments did not reach appropriate values for reliability. Future studies are needed to analyze the psychometric measures of these instruments on a larger sample of patients with IC.