Painful bladder syndrome/interstitial cystitis
Painful bladder syndrome (PBS) is the term used to refer to a chronic symptom complex of urinary frequency and bladder 'pressure', discomfort or pain in the absence of any other reasonable cause for these symptoms (such as infection). Interstitial cystitis (IC) is the established term used by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) consensus workshop for which a research definition was formulated in the late 1980s. Opinion varies regarding not only definition but also the usefulness of diagnostic investigations such as urodynamic assessment and the potassium sensitivity test. There are still controversies concerning the most basic investigation of cystoscopy in PBS/IC. New developments in the study of PBS/IC include the identification of a potential urinary biomarker, antiproliferative factor (APF), which is produced by urothelial cells in IC and thought to inhibit proliferation. In addition, condition-specific validated questionnaires should aid evaluation, and a growing number of randomised controlled trials should enable clinicians to use evidence-based therapeutic options.
Available from: PubMed Central
- "However, this method does not result in a good long-term treatment outcomes; therefore, many physicians have opposed its use [6,7]. Subsequently, a variety of therapeutic approaches have been attempted, including oral drug administration, intravesical drug instillation, and surgical treatment ; however, no effective treatment has yet been developed. Fall et al.  analyzed and reported the evidence level and recommendation grade of various treatment methods in an IC study published between 2003 and 2007 . "
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ABSTRACT: Many treatment options to help relieve the symptoms of interstitial cystitis (IC) are available, but none are effective. Because no reports of transurethral ulcer resection with hydrodistention are available, we assessed the effects of such combined surgery for ulcerative IC.
Between June 2006 and June 2011, 87 female patients with IC who underwent transurethral resection with hydrodistention and were followed up for at least 12 months were included. Improvements in patients' voiding symptoms and pain were analyzed retrospectively by using a 3-day micturition chart and a 10-point visual analogue scale (VAS) before and after the operation. The global response assessment (GRA) was used to assess treatment satisfaction.
The mean age of the 87 female patients was 59.1±10.1 years, and the mean follow-up period was 26.7±14.4 months. Mean maximum functional bladder capacity increased from 168.4±92.4 mL to 276.3±105.4 mL (1 month) and to 227.3±91.7 mL (12 months). The mean frequency of voiding decreased from 17.2±8.5 before to 10.6±5.3 after (1 month) surgery; however, it increased again to 13.3±4.8 at 12 months. The 10-point VAS score decreased from 9.1±0.8 to 1.2±0.3 (1 month); however, it increased again to 2.5±0.4 (3 months), 3.2±0.4 (6 months), and 5.3±0.5 (12 months) (p<0.001). Symptom improvement based on the GRA was observed in 83 of the 87 patients (95.4%) at 1 month and in 55 of 87 patients (63.2%) at 12 months.
Transurethral resection with hydrodistention is an effective treatment option for ulcerative IC because it provides improvements in voiding symptoms and pain.
Korean journal of urology 10/2013; 54(10):682-8. DOI:10.4111/kju.2013.54.10.682
Available from: Carlo Moll
- "Inclusion criteria require a cystoscopy under anesthesia positively identifying Hunner's ulcer or glomerulations (bleedings of the bladder wall upon hydrodistension). Other inclusion criteria are bladder pain and/or urinary urgency . The NIDDK excludes patients with a bladder capacity larger than 350 ml, patients with a symptom duration of less than nine months, patients with urinary frequency less than eight times a day and with an absence of nocturia, and patients who can successfully be treated with antimicrobials, urinary antiseptics, anticholinergics or antispasmodics. "
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ABSTRACT: Interstitial cystitis (IC), a chronic bladder disease with an increasing incidence, is diagnosed using subjective symptoms in combination with cystoscopic and histological evidence. By cystoscopic examination, IC can be classified into an ulcerative and a non-ulcerative subtype. To better understand this debilitating disease on a molecular level, a comparative gene expression profile of bladder biopsies from patients with ulcerative IC and control patients has been performed.
Gene expression profiles from bladder biopsies of five patients with ulcerative IC and six control patients were generated using Affymetrix GeneChip expression arrays (Affymetrix--GeneChip Human Genome U133 Plus 2.0). More than 31,000 of > 54,000 tested probe sets were present (detection p-value < 0.05). The difference between the two groups was significant for over 3,500 signals (t-test p-value < 0.01), and approximately 2,000 of the signals (corresponding to approximately 1,000 genes) showed an IC-to-healthy expression ratio greater than two. The IC pattern had similarities to patterns from immune system, lymphatic, and autoimmune diseases. The dominant biological processes were the immune and inflammatory responses. Many of the up-regulated genes were expressed in leukocytes, suggesting that leukocyte invasion into the bladder wall is a dominant feature of ulcerative IC. Histopathological data supported these findings.
GeneChip expression arrays present a global picture of ulcerative IC and provide us with a series of marker genes characteristic for this subtype of the disease. Evaluation of biopsies from other bladder patients with similar symptoms (e.g. patients with non-ulcerative IC) will further indicate whether the data presented here will be valuable for the diagnosis of IC.
BMC Genomics 04/2009; 10(1):199. DOI:10.1186/1471-2164-10-199 · 3.99 Impact Factor
Available from: Barbara Shorter
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ABSTRACT: The etiology of interstitial cystitis (IC)/painful bladder syndrome (PBS), a debilitating, multifactorial syndrome of the bladder, eludes doctors. Various causes have been speculated. Consequently IC/PBS is a complex condition to treat. Among the non-traditional approaches used for IC/PBS, dietary changes seem to improve symptoms in some individuals. Most of the data gathered on diet as it affects IC/PBS symptoms is anecdotal. There is a large cohort of IC/PBS patients whose symptoms are exacerbated by ingestion of specific comestibles. The most frequently reported and the most bothersome comestibles include items such as alcoholic beverages, coffee, tea, carbonated beverages, tomatoes and tomato products, and certain spices. A registered dietitian should be consulted so that patients can undertake an elimination diet. After the offending foods have been determined, a diet can be developed to avoid problematic foods and beverages, while meeting daily nutrient requirements.
Topics in clinical nutrition 09/2006; 21(4):312–319. DOI:10.1097/00008486-200610000-00008
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