Suprapubic Pain Research Articles

YAVAKSARA WITH MADHU ANUPANA IN LOWER URINARY TRACT INFECTION: A CASE REPORT

Urinary tract infection is the commonest of all infections and are leading causes of morbidity and health care expenditure in persons of all ages. The prevalence of UTI was estimated to be around 150 million per year. E coli is the most common organism causing UTI. The Common clinical manifestations are dysuria, burning micturition, increased frequency and urgency to micturate, nocturia, suprapubic pain and low-grade fever. In Ayurveda it can be correlated with mutrakrichra. Paneeya kṣāra is one among the important formulation that is mentioned in the management of mutrakrichra. As per textual reference Yavakṣāra have action in relieving symptoms of mutrakrichra. A 34-year-old female with OP No. 20220000308 consulted Shalyatantra OPD of hospital with symptoms of dysuria, suprapubic pain, burning sensation, urgency and frequency of urination. After urinalysis, the condition was diagnosed as lower UTI. The patient was administered 500 mg of yavaksara with madhu anupana twice daily for a period of 15 days and analyzed the condition. Along with reduction in pus cells and bacteria, great symptomatic relief was obtained. Utilizing the inherent properties of ksara, it can be employed with efficacy in the treatment of urinary tract infections.

Antinociceptive effect of the calcitonin gene-related peptide receptor antagonist BIBN4096BS in mice with bacterial cystitis.

Patients with urinary tract infections (UTIs) suffer from urinary frequency, urgency, dysuria, and suprapubic pain, but the mechanisms by which bladder afferents sense the presence of uropathogens and encode this information is not well understood. Calcitonin gene-related peptide (CGRP) is a 37-mer neuropeptide found in a subset of bladder afferents that terminate primarily in the lamina propria. Here, we report that the CGRP receptor antagonist BIBN4096BS lessens lower urinary tract symptoms and prevents the development of pelvic allodynia in mice inoculated with uropathogenic Escherichia coli (UPEC) without altering urine bacterial loads or the host immune response to the infection. These findings indicate that CGRP facilitates the processing of noxious/inflammatory stimuli during UPEC infection. Using fluorescent in situ hybridization, we identified a population of suburothelial fibroblasts in the lamina propria, a region where afferent fibers containing CGRP terminate, that expresses the canonical CGRP receptor components Calcrl and Ramp1. We propose that these fibroblasts, in conjunction with CGRP+ afferents, form a circuit that senses substances released during the infection and transmit this noxious information to the central nervous system.NEW & NOTEWORTHY Afferent C fibers release neuropeptides including calcitonin gene-related peptide (CGRP). Here, we show that the specific CGRP receptor antagonist, BIBN409BS, ameliorates lower urinary tract symptoms and pelvic allodynia in mice inoculated with uropathogenic E. coli. Using fluorescent in situ hybridization, we identified a population of suburothelial fibroblasts in the lamina propria that expresses the canonical CGRP receptor. Our findings indicate that CGRP contributes to the transmission of nociceptive information arising from the bladder.

Lower urinary tract effects of ureteral stent length and intravesical position.

Ureteral stents can cause lower urinary tract problems such as stent-related irritative symptoms and urinary tract infections. This study aimed to determine the lower urinary tract effects of ureteral stent length and intravesical position in children. Patients who underwent double-J stenting after urological procedures between January 2017 and January 2022 were included in the study. The patients were assessed in terms of age, irritative symptoms, urinary tract infections, and stent length. The intravesical position of the ureteral stents was grouped as cross-trigonal and ipsilateral. The distribution of irritative symptoms, frequency of urinary tract infections and stent length were analyzed according to intravesical location. A total of 47 patients were included in the study. The median age was 5years (range: 1-16). Cross-trigonal stent position was significantly associated with symptoms of urgency (p = 0.046), suprapubic pain (p = 0.002), and lower mean age (p = 0.004). Urinary tract infections were more frequent in patients whose placed stents were longer than recommended (p < 0.001) or were in cross-trigonal position (p = 0.043). Our results suggest that stent-related irritative symptoms and urinary tract infections can be reduced in pediatric patients using a suitably sized ureteral stent and considering its intravesical position.

Successful use of a phage endolysin for treatment of chronic pelvic pain syndrome/chronic bacterial prostatitis.

Chronic prostatitis (CP) is a common inflammatory condition of the prostate that is estimated to effect 2%-10% of the world's male population. It can manifest as perineal, suprapubic, or lower back pain and urinary symptoms occurring with either recurrent bacterial infection [chronic bacterial prostatitis (CBP)] or in the absence of evidence of bacterial infection [chronic pelvic pain syndrome (CPPS)]. Here, in the case of a 39 years-old CBP patient, we report the first successful use of a bacteriophage-derived muralytic enzyme (endolysin) to treat and resolve the disease. Bacteriological analysis of the patient's prostatic secretion and semen samples revealed a chronic Enterococcus faecalis prostate infection, supporting a diagnosis of CBP. The patient's E. faecalis strain was resistant to several antibiotics and developed resistance to others during the course of treatment. Previous treatment with multiple courses of antibiotics, bacteriophages, probiotics, and immunologic stimulation had failed to achieve long term eradication of the infection or lasting mitigation of the symptoms. A cloned endolysin gene, encoded by E. faecalis bacteriophage ϕEf11, was expressed, and the resulting gene product was purified to electrophoretic homogeneity. A seven-day course of treatment with the endolysin resulted in the elimination of the E. faecalis infection to below culturally detectable levels, and the abatement of symptoms to near normal levels. Furthermore, during the endolysin treatment, the patient experienced no untoward reactions. The present report demonstrates the effectiveness of an endolysin as a novel modality in managing a recalcitrant infection that could not be controlled by conventional antibiotic therapy.

Diagnostic and antibiotic stewardship lessons: an outpatient assessment of symptomatic reflex urinalysis ordering accuracy using an electronic best-practice alert.

It is not well known how reliably clinicians order reflex urinalysis to microscopy and culture (rUA-cx) for outpatient urinary tract infection (UTI) workup. Antibiotic appropriateness cannot be fully appreciated until the prevalence of UTIs and asymptomatic bacteriuria (ASB) are realized. This quality improvement study has two major aims, first to determine UTI symptom accuracy for rUA-cx ordering and second, to confirm UTI and ASB cases by integrating rUA-cx and cascaded urinalysis results. Antibiotic utilization and diagnostic coding were secondarily linked to UTIs and ASB. An electronic best-practice alert informed the ordering of two rUA-cx options: symptomatic- rUA-cx specifically for dysuria, frequency, urgency, costovertebral pain, suprapubic pain or fever versus non-specific-rUA-cx for vague complaints. UTI symptoms were verified by chart review. Confirmed UTI was defined as a significant culture with UTI symptoms and ASB as a significant culture without UTI symptoms. rUA-cx (2065) were prospectively collected over 6 months from female patients at risk for uncomplicated UTIs. Symptomatic-rUA-cx and non-specific-rUA-cx were associated with UTI symptoms for 53% (809/1527) and 20% (107/538), respectively. Overall, 44% (916/2065) of all rUA-cx had UTI symptoms. rUA-cx were overordered by a factor of 9 (2065/225) for every confirmed UTI. The UTI-to-ASB relative ratio was 2.6 (225/86). Regarding UTI-relevant antibiotics, 39% (214/553) were appropriately associated with UTI whereas only 22% (74/339) of inappropriate antibiotics were captured by the ASB definition, underestimating the problem 4-fold. UTI and ASB remain challenging to categorize despite a meticulous method that applied acceptable criteria.

Antireflux Ureteral Stent Improves Stent-Related Symptoms and Quality of Life: A Prospective Randomized Controlled Trial.

Objectives: To compare the effectiveness of antireflux ureteral stents on improving symptoms and quality of life of patients with ureteral stents. Materials and Methods: We randomized 120 patients with ureteral stone who required ureteral stent placement after ureteroscopic lithotripsy, of which 107 (56 in standard ureteral stent group and 51 in antireflux ureteral stent group) entered the final analysis. Severity of flank pain and suprapubic pain, visual analog scale (VAS), analgesic used after hospitalization, back soreness during micturition, gross hematuria, creatinine abnormality, hydronephrosis grade, symptomatic urinary tract infection (UTI), and quality of life were compared between the two groups. Results: There were no serious complications after operation in all 107 cases. The antireflux ureteral stent group had less flank pain and suprapubic pain (p < 0.05), analgesic used after hospitalization (p < 0.05), back soreness during micturition (p < 0.05), and lower VAS (p < 0.05). The health status index scores (p < 0.05), dimensions of usual activities, and pain/discomfort (p < 0.05) in the antireflux ureteral stent group were statistically better than those in the standard ureteral stent group. There were no significant differences between the groups in creatinine abnormality, hydronephrosis grade, gross hematuria, and symptomatic UTI. Conclusions: The antireflux ureteral stent has the same safety and efficacy as the standard ureteral stent, and is significantly better than the standard ureteral stent in flank pain and suprapubic pain, VAS, analgesic used after hospitalization, back soreness during micturition, and quality of life.

Urinary Symptoms Among People With Neurogenic Lower Urinary Tract Dysfunction (NLUTD) Vary by Bladder Management.

To determine whether assessment and decision-making around urinary symptoms in people with neurogenic lower urinary tract dysfunction (NLUTD) should depend on bladder management. Three surveys of urinary symptoms associated with NLUTD (USQNBs) were designed specific to bladder management method for those who manage their bladders with indwelling catheter (IDC), intermittent catheter (IC), or voiding (V). Each was deployed one time to a national sample. Subject matter experts qualitatively assessed the wording of validated items to identify potential duplicates. Clustering by unsupervised structural learning was used to analyze duplicates. Each item was classified into mutually exclusive and exhaustive categories: clinically actionable ("fever"), bladder-specific ("suprapubic pain"), urine quality ("cloudy urine"), or constitutional ("leg pain"). A core of 10 "NLUTD urinary symptoms" contains three clinically actionable, bladder-specific, and urine quality items plus one constitutional item. There are 9 (IDC), 11 (IC), and 8 (V) items unique to these instruments. One decision-making protocol applies to all instruments. Ten urinary symptoms in NLUTD are independent of bladder management, whereas a similar number depend on bladder management. We conclude that assessment of urinary symptoms for persons with NLUTD should be specific to bladder management method, like the USQNBs are.

Clinical factors and diagnoses associated with inappropriate urine-culture ordering in primary care

Background: Inappropriate urine-culture ordering is associated with increased antibiotic prescribing in myriad care environments, including acute and long-term care. In primary care, where urinary tract infections (UTIs) are commonly encountered, the appropriateness of urine-culture ordering has not been well described. We examined the appropriateness of urine-culture ordering and factors associated with inappropriate urine-culture ordering in primary care. Methods: We conducted a secondary analysis of data from a previous prospective study that included patients aged ≥18 years presenting with provider-suspected UTI with an accompanying urine culture at 2 safety-net, primary-care clinics in Houston, Texas, between November 2018 and March 2020. Patients with complicated or uncomplicated UTI were included, but those with a urinary catheter and pregnant females were excluded. Urine cultures were considered appropriate if the patient had an evidence-based symptom of UTI (ie, dysuria, frequency, urgency, hematuria, fever, chills, costovertebral angle tenderness, suprapubic, pelvic, or flank pain, or nephrolithiasis) as a diagnostic code or listed in providers’ free-text documentation. Diagnostic codes for symptoms that were not evidence based were grouped into categories based on body system, visit type (eg, routine visit), or sign or symptom clusters. We evaluated the relationships among demographic and clinical factors, the clinic visited, and non–evidence-based diagnostic codes with inappropriately ordered cultures. Results: We examined 870 cultures from 807 patients. Overall, 61.5% of patients were Hispanic (61.5%) and 23% were African American or Black. Also, 70.6% were women; the mean age was 49.2 years (SD, 14.6); and the mean Elixhauser score was 1.9 (SD, 5.4). Among the 870 cultures, 210 (24%) were ordered inappropriately. Dysuria (n = 289), frequency (n = 129), and UTI or cystitis (n = 117) were the most common, evidence-based codes among appropriate cultures. In the adjusted model, the nonteaching clinic (aOR, 6.33) and diagnostic codes comprising the following categories were associated with inappropriate culturing: acute lower back pain (aOR, 5.42), cardiac-related visits (aOR, 2.41), urinary incontinence (aOR, 4.46), routine health visits (aOR, 3.66), urine characteristics (aOR, 14.32), voiding difficulties (aOR, 3.88), and well-woman visits with a gynecological exam or family planning aspect (aOR, 12.27) (all P &lt; .05). Conclusions: This research highlights potential gaps or miscues in provider behavior related to urine culture ordering, and unveiled problematic culturing related to urine characteristics and to routine visits, especially of a gynecological nature. This information can be incorporated into diagnostic stewardship interventions to address misconceptions, and to further explore the reasoning or processes wherein urine cultures are ordered for routine visits.Financial support: NIAID UM1AI104681Disclosure: None

Intravesical Bladder Treatment and Deep Learning Applications to Improve Irritative Voiding Symptoms Caused by Interstitial Cystitis: A Literature Review.

Our comprehension of interstitial cystitis/painful bladder syndrome (IC/PBS) has evolved over time. The term painful bladder syndrome, preferred by the International Continence Society, is characterized as "a syndrome marked by suprapubic pain during bladder filling, alongside increased daytime and nighttime frequency, in the absence of any proven urinary infection or other pathology." The diagnosis of IC/PBS primarily relies on symptoms of urgency/frequency and bladder/pelvic pain. The exact pathogenesis of IC/PBS remains a mystery, but it is postulated to be multifactorial. Theories range from bladder urothelial abnormalities, mast cell degranulation in the bladder, bladder inflammation, to altered bladder innervation. Therapeutic strategies encompass patient education, dietary and lifestyle modifications, medication, intravesical therapy, and surgical intervention. This article delves into the diagnosis, treatment, and prognosis prediction of IC/PBS, presenting the latest research findings, artificial intelligence technology applications in diagnosing major diseases in IC/PBS, and emerging treatment alternatives.

Necrotizing Fasciitis of the Abdominal Wall Secondary to Complicated Appendicitis: A Case Report

Acute appendicitis is one of the most common surgical emergencies worldwide. Many complications can occur secondary to complicated appendicitis including abscess formation, gangrene, sepsis, and perforation, rarely, leading to abdominal wall necrotizing fasciitis. The incidence of necrotizing fasciitis as a complication of ruptured appendicitis is extremely uncommon. The formation of an enterocutaneous fistula leading to this complication further emphasizes the rarity of such occurrence with few cases reported in the literature. Herein, we present a case of abdominal wall necrotizing fasciitis in a 72-year-old female presenting to the local emergency room with complaints of severe suprapubic abdominal pain associated with abdominal distension and acute onset foul-smelling drainage. Physical exam was significant for suprapubic and right lower quadrant abdominal tenderness with associated large indurated tender lesion and purulent weeping with large ecchymosis. Abdominal computed tomography (CT) revealed extensive subcutaneous emphysema, a large cavity with layering fluid extending into the peritoneal space, and a possible fistula formation between the intra-abdominal cavity and subcutaneous tissue. Following the diagnosis of probable necrotizing fasciitis secondary to fistula formation, the patient underwent emergent exploratory laparotomy and extensive debridement of necrotic tissue. In this report, we take the opportunity to highlight the importance of promptly recognizing and treating this uncommon complication and maintaining a high level of suspicion to prevent life-threatening consequences.

Obstructive Fibroepithelial Polyp Mimicking a Tumor in a 3-Year-Old Child

In this article we discusse the case of a 3-year-old child diagnosed with a fibroepithelial polyp of the bladder, a rare benign lesion typically found in infants and children. The child presented with hematuria, suprapubic pain, and dysuria, and an ultrasound revealed a tumor-like vesical process obstructing the left ureteral meatus and causing moderate ipsilateral hydronephrosis. The presence of vascularity on color Doppler raised concerns of a malignancy such as vesical rhabdomyosarcoma or inflammatory pseudotumor. Diagnostic and therapeutic cystoscopy revealed a left ureteral polyp, and complete resection was performed. The pathological examination suggested an inflammatory pseudopolyp, and the patient's outcome was positive. The article discusses the rarity of this condition in children, its clinical symptoms, diagnosis, and management.

Haga su diagnóstico

A 63-year-old male patient admitted to ER due to dysuria, fever, suprapubic pain, and urinary retention since 3 days ago. Laboratory studies evidence of leukocytosis and neutrophilia. Renal and hepatic function preserved. Medical history reveals repeated prostatitis and diabetes type 2.

Interstitial cystitis caused by immune dysregulation in LRBA deficiency: one among the rare urological manifestations in inborn errors of immunity

Inborn errors of immunity (IEI) rarely present with associated urological manifestations. Chronic cystitis and urethritis caused by ureaplasma and mycoplasma infection in hypogammaglobulinemia may result in bladder fibrosis. Papovaviridae such as BK or JC, can cause hemorrhagic cystitis in patients with T cell defects. Bladder granulomtata and urethral strictures can occur in chronic granulomatous disease. This is the first reported case of severe lymphocytic interstitial cystitis in a patient with lipopolysaccharide-responsive beige-like anchor protein (LRBA) deficiency. LRBA deficiency is known to impair CTLA-4 recycling, leading to decreased Treg cell function. A 13 year old male refugee presented with chronic recurrent debilitating suprapubic pain and dysuria, which progressed to extreme urinary frequency. He had a prior history of recurrent aseptic urinary tract infections, and one episode of gross hematuria. Extensive infectious investigations of urine (bacterial, mycobacterial cultures; viral PCRs), blood, and stool (Schistosoma) failed to isolate a pathogen. Bladder biopsy was positive for EBV by PCR but blood remained EBV-negative. Urinalysis showed microscopic hematuria while urodynamic studies were normal, and cystoscopy showed bladder and urethral irritation. Pathology confirmed lymphocytic interstitial cystitis, with primarily T cell infiltration. Immunological investigations revealed low IgG, IgA and IgM levels, B lymphopenia (1%), with low class-switched memory B cell development (3%) and absent response to protein and polysaccharide vaccine antigens. There were no signs of autoimmunity. Parents are consanguineous, and a sibling was likewise diagnosed with LRBA deficiency. Sanger sequencing of DNA confirmed the same homozygous family mutation in the LRBA gene, a likely pathogenic splice donor variant, c.2258+2T>G. The patient was started on immunoglobulin replacement. Trials of analgesics including NSAIDs, gabapentin, and morphine, and immunosuppression with corticosteroids and sirolimus, were unsuccessful in reducing urinary symptoms. Physiotherapy and antispasmodics were introduced when pelvic-floor dyssynergia with rectal pain developed. Subsequently-presenting enteropathy was managed with Abatacept (CTLA-4 IgG1 fusion protein), ultimately improving bladder symptoms after several months of therapy. Patient has since undergone HSCT and is now free of urinary tract symptoms. LRBA deficiency presents with hypogammaglobulinemia, infections, and immune dysregulation presenting with lymphocytic infiltration of non-lymphoid organs. This report highlights the phenotypic diversity of this disease.

A FOUR-YEAR FORGOTTEN URINARY CATHETER IN A SEXUALLY ACTIVE YOUNG MALE AND ITS MANAGEMENT: A CASE REPORT

The urinary catheters’ mean indwelled duration after PIUR (primary interventional urethral realignment) is 25 days. Only four cases of forgotten urinary catheter were reported in the literature. The objective of this clinical case report is to highlight the unusual finding of a four-years forgotten urinary catheter in a young sexually active 23-year-old man and its management, aspiring future similar endeavors. A 23-year-old man presented to the hospital exhibiting severe supra-pubic pain and inability to urinate for one day. He described undergoing PIUR for a traumatic urethral rupture four years ago. An indwelling urinary catheter was placed subsequently, that he claims being removed by his physician 21 days later. Urinary hesitancy and frequency were reported since then, maintaining normal sexual activity. Based on having a tender vesicular globe, and a disclosed rod inside his penis, he was diagnosed with urinary retention by a foreign body and admitted to the hospital for further investigations. Vesicular decompression by a supra-pubic catheter was performed. A non-contrast pelvic CT scan revealed a calcified elongated structure suspecting an encrusted retained urinary catheter. In the operating room, rigid ureteroscope with the assistance of lithotripsy were proficient in fragmenting only intra-urethral calcifications. Sequentially, an open cystolithotomy evacuated the remaining calcified vesicular balloon. Patient was asymptomatic on subsequent visits denying any urinary symptoms and stating normal sexual activity. Removing such a foreign body, especially when severely encrusted as well as avoiding trauma to the urethra while minimizing patient morbidity remain a clinical confront for the surgeon. Hence, minimally invasive procedures are always preferred. In this case, we had to assist the rigid ureteroscope and the lithotripsy by an open cystolithotomy for the large calcified balloon. Nevertheless, this method has proved to be safe and efficient. Thus, it is suggested to be used in future comparable cases.

Primer Dismenorede D Vitaminin Rolü

Primary dysmenorrhea is uterine cramping that occurs during or before menstruation without pelvic disease and causes suprapubic pain. In researching the causes of dysmenorrhea, several studies have highlighted the role of lacking vitamin D (vit D). Vit D acts by suppressing the synthesis of prostaglandins that cause pain. Our study aims to investigate whether vit D level affects primary dysmenorrhea. For this purpose, vit D 3 level will be studied in patients with primary dysmenorrhea and a control group without dysmenorrhea. This retrospective, randomized, case-controlled study was conducted between January 2020 and August 2021 at two different centers. It was approved by the ethics committee. Information was obtained by interviewing eligible subjects for the study, and informed consent was obtained. 750 women presented to the gynecology departments of the participating centers involved in the study. Ages between 16-35 are included in the study. Under 18 patients were referred from pediatric clinics with similar symptoms. 325 women were assigned to the dysmenorrhea group. All patients had a regular menstrual cycle and pain that began the day before menstruation. 325 patients unrelated to dysmenorrhea were selected randomly as a control group. The participants in our study were randomly selected into the dysmenorrhea group and the control group, and their clinical characteristics were compared in Tables 1 and 2. Significance was remarkable comparing the dysmenorrhea patients with the healthy control groups. That dysmenorrhea patients with 25-hydroxyvitamin D3 deficiency had significantly less consumption of dairy products. VAS values were higher, and undereducation and unemployment were also significantly more common. Low serum vit D levels and dysmenorrhea are strongly related. It is obvious that there is a significant relationship between vit D levels, VAS score, and primary dysmenorrhea. More studies at larger scales are needed to underline the efficiency of vit D in primary dysmenorrhea.

MP15-09 TADALAFIL VERSUS COMBINED TAMSOLUSIN AND CIPROFLOXACIN FOR TREATMENT OF CHRONIC PELVIC PAIN SYNDROME: A RANDOMIZED CONTROLLED TRIAL

You have accessJournal of UrologyCME1 Apr 2023MP15-09 TADALAFIL VERSUS COMBINED TAMSOLUSIN AND CIPROFLOXACIN FOR TREATMENT OF CHRONIC PELVIC PAIN SYNDROME: A RANDOMIZED CONTROLLED TRIAL Marwan Anas, Ahmed EL-Hefnawy, and Ahmed Shoma Marwan AnasMarwan Anas More articles by this author , Ahmed EL-HefnawyAhmed EL-Hefnawy More articles by this author , and Ahmed ShomaAhmed Shoma More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003235.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Chronic prostatitis /Chronic pelvic pain syndrome (CP/CPPS) is still presenting true considerable challenge to urologists .It is characterized by confluence of symptoms including mainly suprapubic or deep perineal pain, and voiding symptoms. The exact etiology and pathogenesis of CP/CPPS remain unknown up till now. A specific diagnostic test for CP/CPPS is still not yet determined. Until now, there are no proven therapies for CP/CPPS. A wide variety of pharmacologic and non-pharmacologic therapies have been studied in clinical trials, but most have shown limited curative efficacy in symptom alleviation. Our aim To assess the efficacy and safety of PDEI-5 (Tadalafil) for treatment of CP/CPPS. METHODS: It is a prospective randomized controlled single blinded phase III clinical trial. Between May 2020 and April 2022, 97 patients with a diagnosis of type IIIa chronic non-bacterial prostatitis were enrolled in the final analysis at the end of study. Forty-nine for tadalafil (group A), who received combined tadalafil 5 mg once daily before bed time and placebo (sugar pills) after meal once daily for 12 weeks and forty-eight for combined tamsulosin and ciprofloxacin (group B) who received ciprofloxacin 1000 mg once daily PO after meal and tamsulosin 0.4 mg before bed time for the same period. Patients were followed for 12 weeks after administration of treatment. Primary end point was pain relief which was assessed by NIH-CPSI at 12 weeks after treatment. RESULTS: Patients baseline characteristics were comparable in both groups. At the end of RCT, tadalafil-group patients showed significant improvement in total, pain, urinary and Qol domains of NIH-CPSI compared to baseline (17.92±2.3, 7.41±1.56, 4.96±0.86, 5.55±0.79 vs. 30.88±3.62, 14.67±2.2, 6.67±1.17, 9.53±1.15 respectively, p<0.0001). When compared to combined tamsulosin and ciprofloxacin, all 12th week NIH-CPSI domains scores, except for urinary, were significantly better in tadalafil group (p<0.0001). Side-effects among group B were much higher than in group A. The most common side-effects in group A were dyspepsia (8.2%) and back pain (6.1%) while in group B were retrograde ejaculation (18.8%) and dizziness (16.7%). By the end of 12th week, 39 (79.6%) patients in group A showed marked improvement in GRA, while in group B, 41 (85.4%) patients showed moderate improvement. CONCLUSIONS: Tadalafil is effective and safe treatment modality for CP/CPPS. It has the advantage of giving more pain relief and improvement of sexual function compared with combined tamsulosin and ciprofloxacin. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e195 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marwan Anas More articles by this author Ahmed EL-Hefnawy More articles by this author Ahmed Shoma More articles by this author Expand All Advertisement PDF downloadLoading ...

A Rare Case of Eosinophilic Cystitis in an Elderly Male Mimicking as Carcinoma Bladder

Eosinophilic cystitis (EC) is a rare inflammatory condition, first described in 1960 by Brown &amp; Palubinskas.[1] Aetiology remains unclear, although it has been associated with bladder wall injury/allergies in most cases. Histopathologic diagnosis includes transmural inflammation of the urinary bladder with eosinophilia.[2] The patient presents with a spectrum of urological symptoms such as urine frequency (67%), dysuria (62%), gross/microscopic hematuria (68%), suprapubic pain (49%) &amp; urinary retention (10%).[3] In this rare case, an elderly male presenting with clinical &amp; radiological features suggestive of Carcinoma (Ca) bladder ended with a diagnosis of eosinophilic cystitis post-biopsy.

A Case of Eosinophilic Cystitis treated with Mepolizumab

Background: Eosinophilic cystitis is a rare inflammatory cystitis of unknown origin. Common symptoms include urinary frequency, urgency, pain, and recurrent urinary tract infections. Currently used treatments include corticosteroids, anti-inflammatory drugs, antihistamines, and antibiotics. Here we present a case of successful treatment of eosinophilic cystitis with mepolizumab. Case Presentation: A 41-year-old female presented with urinary frequency, urgency, and suprapubic pain. She underwent multiple tests including cystoscopy and biopsy, which revealed a diagnosis of eosinophilic cystitis in 2000. She was initially managed with oral antihistamines and oral steroids. However, over the years her symptoms increased in frequency, intensity, and duration. Montelukast 10 mg daily started which did not show any improvement. In 2017 Mepolizumab 100 mg every 4 weeks started. The patient noted improvement after a few months, and she was tolerating her injections well without side effects and had no further flares of her condition. Discussion: We present a case of eosinophilic cystitis which was refractory to multiple treatments and responded well to mepolizumab. There are no definite guidelines for the management of EC and there is no curative treatment for this disease. Mepolizumab is an anti-IL-5 monoclonal antibody and the use of mepolizumab in the management of EC that is refractory to treatment have been reported in a few cases. The use of mepolizumab has been described in different diseases associated with eosinophilic inflammation such as severe eosinophilic asthma, eosinophilic esophagitis, eosinophilic chronic obstructive pulmonary disease, and severe nasal polyposis. Conclusion: Mepolizumab can be considered a treatment option in EC cases refractory to the standard treatment. At this time, larger studies are needed to evaluate the efficacy and safety of mepolizumab in EC.

Overactive bladder with urodynamic study-induced bladder pain: An overactive bladder subtype with symptoms similar to those of interstitial cystitis/painful bladder syndrome.

Overactive bladder (OAB) and interstitial cystitis/painful bladder syndrome (IC/PBS) are 2 lower urinary tract disorders with urgency and bladder pain for diagnosis and with several other shared symptoms. Because of their overlapping symptoms, precise differential diagnosis of OAB and IC/PBS remains difficult. Thus, we characterize a subgroup of OAB with bladder pain (OAB-BP) that can be differentiated from OAB alone by urodynamic study (UDS) findings. We also further examined the clinical presentations and urodynamic parameters of OAB alone, OAB-BP, and IC/PBS. Data were collected between September 2018 and April 2019. Patients were categorized into 3 groups, OAB-alone (no bladder pain during UDS, n = 39), OAB-BP (with bladder pain during UDS, n = 35), and IC/PBS (the comparator, n = 39). Chi-square tests were used to compare OAB alone, OAB-BP, and IC/PBS with respect to their clinical presentations and urodynamic parameters. Factors with P < .05 were further analyzed through post hoc comparisons with Bonferroni adjustment. An unique subgroup of OAB patients was identified (i.e., OAB-BP), bladder pain can only be induced at maximal cytometric capacity during UDS. We also identified that the case histories and UDS parameters (e.g., low first desire, normal desire, and maximum cytometric capacity) of the OAB-BP group were more similar to those of the IC/PBS group than to those of the OAB-alone group. The OAB-BP group and the IC/PBS group reported more intrusive, longer-lasting symptoms before their final diagnoses, more extensive family history of urinary tract disorder, and more associated comorbidities (e.g., irritable bowel syndrome, and myofascial pain) than the OAB-alone group. The UDS assessment induced bladder pain in the OAB-BP group to reveal their hidden symptoms. Careful attention to patient history and sophisticated UDS evaluation may help to identify this unique OAB group.

Foetal haemoglobin inducers for reducing blood transfusion in non-transfusion-dependent beta-thalassaemias.

Foetal haemoglobin inducers for reducing blood transfusion in non-transfusion-dependent beta-thalassaemias.