ESSIC uses the name bladder pain syndrome (BPS) instead of interstitial cystitis (IC) and/or painful bladder syndrome (PBS): click here for more details.
Bladder pain syndrome international consultation on incontinence Hanno P, Lin A, Nordling J, Nyberg L, van Ophoven A, Ueda T, Wein A. Neurourol Urodyn 2010;29:191-8 - the Bladder Pain Syndrome Committee of the International Consultation on Incontinence was assigned the task by the consultation of reviewing the syndrome, formerly known as interstitial cystitis; this included the topics of definition, nomenclature, taxonomy, epidemiology, etiology, pathology, diagnosis, symptom scales, outcome assessment, principles of management, specific therapies, and future directions in research
- the emphasis was on new
information developed since the last consultation 4 years previously
- the consultation decided to refer to the condition as "bladder pain syndrome" (BPS) because the designation is more descriptive of the clinical condition and better
fits standard classification taxonomy
- reasonable definitions of BPS include the
definition of the ESSIC and a slight modification made at a SUFU sponsored Miami meeting in early 2008. Males or females with pain, pressure, or discomfort that they perceive to be related to the bladder with at least one urinary symptom, such as frequency not obviously related to high fluid intake, or a persistent urge to void should be evaluated for possible BPS
- the initial
assessment consists of a frequency/volume chart, focused physical examination, urinalysis, and urine culture; urine cytology and cystoscopy are recommended if clinically indicated
- the consultation believes that the disorder is best viewed as one of a group of chronic pain syndromes, rather than as primarily an inflammatory bladder disorder
How do patients describe their symptoms of interstitial cystitis/painful bladder syndrome (IC/PBS)? Qualitative interviews with patients to support the development of a patient-reported symptom-based screener for IC/PBS. Abraham L, Arbuckle R, Bonner N, et al. Value Health 2009;12:A310 (abstract)
- patient-reported, symptom-based measures may be
more appropriate than the insensitive NIDDK criteria for identifying IC/PBS patients but existing measures have poor specificity,
likely due to inadequate content validity
- this study conducted qualitative
interviews with patients to identify key IC symptoms, and the language used to
describe them, to develop a new symptom-based IC screener:
44 IC/PBS patients with a confirmed diagnosis in the US, France and Germany were interviewed about their symptoms and subsequent impact on quality
of life; 10 overactive bladder (OAB) patients were also interviewed to improve specificity
- interviews included
open-ended questions, creative tasks and focussed discussion
- key symptoms identified by
IC/PBS patients were the urge to urinate, urination frequency, and pain; urge had four
components: 1) need to urinate driven by pain; 2) a need to urinate to avoid pain
getting worse; 3) a constant need to urinate and; 4) a sudden need to urinate
- in
contrast, OAB patients reported urge that did not involve pain
- both OAB and IC/PBS
patients experienced high day and night-time urination frequency
- IC pain was perceived
to be in the bladder, abdomen or pelvis, and was most commonly described as “pressure”, “burning”, “sharp” and “discomfort”
Validation of a modified national institutes of health chronic prostatitis
symptom index to assess genitourinary pain in both men and women. Clemens JQ, Calhoun EA, Litwin MS, et al. Urology 2009;74:983-7
- the authors
developed the Genitourinary Pain Index (GUPI) by modifying and adding questions
to the NIH-Chronic Prostatitis Symptom Index.
- the GUPI discriminated between men with chronic prostatitis or IC, those with other symptomatic conditions (dysuria,
frequency, chronic cystitis), and those with none of these diagnoses
- the GUPI
also discriminated between women with IC, those with
incontinence, and those with none of these diagnoses
- the GUPI
scores
correlated highly with scores on the Interstitial Cystitis Symptom Index and
Problem Index; the GUPI was highly responsive to change, and the change in score
was similar in both male and female responders
- a reduction of 7 points robustly
predicted being a treatment responder (sensitivity 100%, specificity 76%)
- the authots conclude that the GUPI is a valid, reliable, and responsive instrument that can be
used to assess the degree of symptoms in both men and women with genitourinary
pain complaints
Life impact of urologic pain syndromes. Hatchett L, Fitzgerald MP, Potts J, et al. J Health Psychol 2009;14:741-50
- in this study on the personal experience of chronic urologic pain,
patients were asked to journal in their own words their daily symptoms and the effects of
those symptoms on home/family life, working life and social life
- three major themes were identified
concerning symptoms, personal and interpersonal effects of symptoms and related
role limitations; fatigue emerged as a newly recognized symptom that may benefit
from treatment
Overactive bladder: a new paradigm. Blaivas JG. Int Urogynecol J Pelvic Floor Dysfunct 2009 Oct 29. [Epub ahead of print] PMID: 19865783
A metabonomic approach identifies human urinary phenylacetylglutamine as a novel marker of interstitial cystitis. Fukui Y, Kato M, Inoue Y, et al. J Chromatogr B Analyt Technol Biomed Life Sci. 2009 Sep 26. [Epub ahead of print] PMID: 19815468 • urine samples from 10 patients with IC, 10 with bacterial cystitis and 10 healthy volunteers (HVs) were analyzed to identify an IC marker
• the urinary marker of IC was identified as phenylacetylglutamine (PAGN); the urinary level of PAGN measured relative to creatinine (Cr) was significantly elevated in IC patients (mean 0.47mg/mg Cr) compared with BC patients (mean 0.25mg/mg Cr) and HVs (mean 0.11mg/mg Cr). - • urinary PAGN/Cr ratios in patients with mild and moderate IC were higher than for patients with severe IC
Bladder pain syndrome/interstitial cystitis in a Danish population: a study using the 2008 criteria of the European Society for the Study of Interstitial Cystitis Richter B, Hesse U, Hansen AB, et al. BJU Int 2009 Sep 14. [Epub ahead of print] • in this study, clinical data were obtained retrospectively from medical records for 349 consecutive patients with IC referred to the department of urology of the Copenhagen University Hospital Herlev (Denmark) between 1966 and 2008
• the outcome was expressed in terms of treatment intensity and was correlated with clinical data (pain, nocturnal frequency, bladder capacity, mucosal glomerulations, detrusor mastocytosis, detrusor intrafascicular fibrosis, IFF)
• all patients had pain and 75% had nocturia at least twice. The bladder capacity was <500 mL in 42%; 53% presented with detrusor mastocytosis and 50% with IFF
- the detrusor mast cell count, IFF and nocturnal frequency had prognostic value for treatment intensity, in contrast to bladder capacity and glomerulations
Decreased nanobacteria levels and symptoms of nanobacteria-associated interstitial cystitis/painful bladder syndrome after tetracycline treatment. Zhang QH, Shen XC, Zhou ZS, et al. Int Urogynecol J Pelvic Floor Dysfunct 2009 Sep 17. [Epub ahead of print] • in this study, so-called nanobacteria (NB) were detected in urine and bladder tissue samples of 11 out of 27 patients with BPS
• in these 11 patients, the NB levels decreased dramatically after tetracycline treatment, and the patients reported significant reduction in the severity of BPS symptoms
• the authors suggest that NB may cause some BPS cases Comment:nanobacteria (NB) are said to be very minute
bodies ranging in size from 20 to 500 nm, the smaller ones
filterable through membranes with 100-nm pores, and are observable by scanning electron microscopy or transmission electron microscopy, where they appear as spheres or rods.However, there is no sound evidence for the existence of so-called NB, nor for their bacterial nature. See the following critical paper: Nanobacteria: facts or fancies? Urbano P, Urbano F. PLoS Pathog 2007;3:e55.
Severity of interstitial cystitis symptoms and quality of life in female patients. El Khoudary SR, Talbott EO, Bromberger JT, et al. J Womens Health (Larchmt) 2009;18:1361-8
• symptom severity and being currently unmarried were found to be associated with impairment in quality of life (QOL) in IC patients
• managing pain and nocturia may improve the patients' overall physical QOL
Cystoscopy and bladder biopsies in patients with bladder pain syndrome carried out following ESSIC guidelines. Wyndaele JJ, Van Dyck J, Toussaint N. Scand J Urol Nephrol 2009 Aug 25:1-5. [Epub ahead of print] PMUI:19707951 • 50 patients with BPS symptoms, O'Leary-Sant scores of >12, average pelvic pain VAS scores of >7 out of 10 and no confusable diseases, underwent cystoscopy with hydrodistension and biopsies
• 24% had normal cystoscopy and positive* biopsy (BPS type 1C)
66% had abnormal cystoscopy (glomerulations) and positive biopsy (BPS type 2C)
6% had abnormal cystoscopy (glomerulations) and normal biopsy (BPS type 2A)
4% had abnormal cystoscopy (Hunner's lesion) and positive biopsy (BPS type 3C)
• the authors conclude that the ESSIC recommendations for the cystoscopic and histological diagnosis are easy to apply and permit comparison between patients
• the finding that 24% of the patients could be classified as BPS type 1C (normal findings at cystoscopy with hydrodistension but positive biopsy) clearly proves the additional value of biopsies in the diagnosis of BPS even in the case of normal findings at cystoscopy with hydrodistension • 94% of patients were classified as BPS types 1C, 2C or 3C, showing that 94% of the patients showed signs of present (inflammatory infiltrates, detrusor mastocytosis) or previous (granulation tissue, intrafascicular fibrosis) inflammation
* positive: histological evidence of inflammatory infiltrates, detrusor mastocytosis, granulation tissue or intrafascicular fibrosis
Intravesical liposome versus oral pentosan polysulfate for interstitial cystitis/painful bladder syndrome.
Chuang YC, Lee WC, Lee WC, et al. J Urol 2009 Aug 13. [Epub ahead of print]PMID: 19683290 • in this open study 12 BPS patients were treated withintravesical liposomes and compared with 12 patients treated with oral pentosan polysulfate (PPS)
• intravesical liopsome therapy was found to be safe and the efficacy was similar to that of oral PPS
• limitations of this study were
the lack of placebo control randomization and the small number of patients; the authors indicate that the primary study objective was safety
Chronic pelvic pain. Baranowski AP. Best Pract Res Clin Gastroenterol 2009;23:593-610 · a review on chronic pelvic pain and its taxonomy
Prevalence of Ureaplasma urealyticum and Mycoplasma hominis in women with chronic urinary symptoms. Baka S, Kouskouni E, Antonopoulou S, et al. Urology 2009;74:62-6 • urine, vaginal, and urethral samples from 153 women presenting with chronic voiding symptoms were tested for the presence of pathogens including Ureaplasma urealyticum and Mycoplasma hominis • U. urealyticum was detected 52.9%, and M. hominis 3.3%, always in association with U. urealyticum
• a significant improvement in all symptoms was observed in women with positive cultures for Mycoplasma after therapy
• the authors conclude that testing for the presence of U. urealyticum and M. hominis in the urogenital tract could prove valuable for the management of a significant percentage of chronic urinary symptoms in women through appropriate treatment
Two types of urgency. Blaivas JG, Panagopoulos G, Weiss JP, Somaroo C. Neurourol Urodyn 2009;28:188-90.
Increased vascular endothelial growth factor expression in patients with bladder pain syndrome/interstitial cystitis: its association with pain severity and glomerulations. Kiuchi H, Tsujimura A, Takao T, et al. BJU Int 2009 Mar 4. [Epub ahead of print] • this study showed an increased vascular endothelial growth factor (VEGF) expression and immature vascularization in patients with BPS/IC, and that the VEGF expression was associated with the degree of pain described by patients
• the authors conclude that VEGF might contribute to pain and promote the formation of immature vessels in BPS/IC, and that the increased immature vascularization might have a role in glomerulations in patients with BPS/IC
Bladder outlet obstruction in painful bladder syndrome/interstitial cystitis. Cameron AP, Gajewski JB. Neurourol Urodyn 2009 Mar 19. [Epub ahead of print] • the authors found that 48% of their PBS/IC patients have bladder outlet obstruction, and that increasing severity of PBS/IC was associated with higher voiding pressure
Is there a discrepancy between patient and physician quality of life assessment? Srikrishna S, Robinson D, Cardozo L, et al. Neurourol Urodyn 2008 Dec 4. [Epub ahead of print]
• this study confirms, according to the authors,
that physicians often differ from patients in the assessment of quality of life (QoL)
• this is most likely due to a difference in
patient–physician perception of ‘‘significant’’ lower urinary tract symptoms and clearly demonstrates the importance of patient evaluated
QoL in routine clinical assessment
Epigenetic reprogramming: a possible etiological factor in bladder pain syndrome/interstitial cystitis? Ada Elgavish. J Urol 2009;181:980-4 • the author postulates that transient but severe environmental cues such as noxious stimuli associated with infection and inflammation may trigger epigenetic reprogramming of a subpopulation of stem cells in the urothelium, providing a possible mechanism for transdifferentiation processes
• according to the author, this hypothetical mechanism could explain the apparently unrelated abnormalities associated with the BPS/IC bladder such as epithelial dysfunction, increased numbers of mast cells and neural up-regulation as well as the persistence of an altered state in the absence of the initial signal
• the author also gives examples of how this hypothesis could be tested and suggests that dietary interventions and new treatments could be devised and used in clinical trials to reverse epigenetic changes and alleviate the symptoms of BPS/IC
Evaluation of urgency in women, with a validated Urgency, Severity and Impact Questionnaire (USIQ). Lowenstein L, Fitzgerald MP, Kenton K, et al. Int Urogynecol J Pelvic Floor Dysfunct. 2008 Nov 20. [Epub ahead of print] PMID: 19020786 • the aim of this study was to develop and validate a urinary urgency questionnaire to measure the severity and quality of life (QOL) impact from urinary urgency, in order to advance the clinical understanding of
urinary urgency, and ultimately to guide the evaluation and treatment of patients with OAB • the USIQ comprises five
symptom severity items and eight QOL items
• click the title above for the full article (it is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited)
Intravesical alkalinized lidocaine (PSD597) offers sustained relief from symptoms of interstitial cystitis and painful bladder syndrome. Nickel JC, Moldwin R, Lee S, Davis EL, et al. BJU Int 2008 Nov 13. [Epub ahead of print].PMID: 19021619 • study design: randomized placebo-controlled double blind trial - 5-day course of treatment with PSD597 (200 mg lidocaine, alkalinized with a sequential instillation of
8.4% sodium bicarbonate solution, to a final
volume of 10 mL) or placebo (double-blind) - follow-up 29 days - efficacy was assessed by
changes in the Global Response Assessment
(GRA), Likert scales for bladder pain, urgency
and frequency, and validated O’Leary-Sant IC symptom and problem indices. • the authors conclude that this preliminary study showed that intravesical alkalinized lidocaine (PSD597)
was effective for providing sustained
amelioration of symptoms of IC/PBlS beyond
the acute treatment phase
• the drug was
found to be safe, well tolerated and devoid of the
systemic side-effects often experienced with oral drug administration
• long-term studies
are needed to determine the optimum
regimen to maintain this favourable
treatment effect
A real-life multicentre clinical practice study to evaluate the efficacy and safety of intravesical chondroitin sulphate for the treatment of interstitial cystitis. Nickel JC, Egerdie B, Downey J, et al. BJU Int 2008 Sep 3. [Epub ahead of print] • a multicentre, community based open-label study designed to assess the efficacy and safety of intravesical sodium chondroitin sulphate in the treatment of patients with the clinical diagnosis of interstitial cystitis (IC)
• patients with IC were treated with sodium chondroitin sulphate (Uracyst®) solution 2.0% via urinary catheter weekly for 6 weeks and then monthly for 16 weeks for a total of 10 treatments
• the primary endpoint was the percentage of responders to treatment as indicated by a marked or moderate improvement on a seven-point patient Global Response Assessment (GRA) scale at week 10 (4 weeks after the initial six treatments) compared with baseline; a secondary efficacy endpoint (durability) was the percentage of responders on the GRA scale after 10 treatments.
• 47% of the 53 enrolled patients with long standing moderately severe IC were responders at week 10; at 24 weeks, 60% were responders
The role of cystoscopy in the diagnosis of Hunner's ulcer disease. Braunstein R, Shapiro E, Kaye J, Moldwin R. J Urol 2008;180:1383-6
- this study shows that standard clinical evaluation cannot reliably distinguish IC patients with and without a Hunner's lesion - the authors conclude that cystoscopy is needed to accurately identify patients with Hunner's ulcer
notes:
• in this study, the diagnosis of IC was strictly made according to the NIDDK criteria implying that cystoscopy with hydrodistension was done
• According to ESSIC, Hunner's ulcer is not an ulcer but rather a
distinctive inflammatory lesion presenting a characteristic
deep rupture through the mucosa and
submucosa provoked by bladder distention. The
word ‘‘ulcer’’ suggests that it can be seen at
cystoscopy without hydrodistention. Consequently,
ESSIC replaced the name Hunner’s ulcer by Hunner’s
lesion. The following definition by Fall was
accepted. ‘‘The Hunner’s lesion typically presents
as a circumscript, reddened mucosal area with small
vessels radiating towards a central scar, with a fibrin
deposit or coagulum attached to this area. This site
ruptures with increasing bladder distension, with
petechial oozing of blood from the lesion and the
mucosal margins in a waterfall manner. A rather
typical, slightly bullous edema develops post-distension
with varying peripheral extension."See also: Diagnostic Criteria, Classification, and Nomenclature for Painful Bladder Syndrome/Interstitial Cystitis: An ESSIC Proposal. Eur Urol 2008;53:60-7
Chronic pelvic pain syndrome and the overactive bladder: the inflammatory link. Saini R, Gonzalez RR, Te AE. Curr Urol Rep 2008;9:314-9 • this paper reviews the role of cytokines in the pathophysiology of chronic prostatitis/chronic pelvic pain syndrome, overactive bladder, and painful bladder syndrome/interstitial cystitis
Prevalence and psychosocial correlates of symptoms suggestive of painful bladder syndrome: results from the Boston Area Community Health Survey. Link CL, Pulliam SJ, Hanno PM, et al. J Urol. 2008 Jun 11. [Epub ahead of print] •the overall prevalence of symptoms suggestive of painful bladder syndrome was 2% (1.3% in men and 2.6% in women) with increased prevalence in middle-aged adults and those of lower socioeconomic status • symptoms suggestive of painful bladder syndrome were more common in those who experienced abuse, in those who were worried about someone close to them and in those who were having trouble paying for basics; this pattern held even after adjusting for depression. • the authors conclude that painful bladder syndrome is associated with a number of lifestyle and psychosocial correlates, suggesting that the treatment may benefit from a multifaceted approach of combining medical, psychological and cognitive treatment.
Resiniferatoxin in the treatment of interstitial cystitis: a systematic review. Mourtzoukou EG, Iavazzo C, Falagas ME. Int Urogynecol J Pelvic Floor Dysfunct 2008 Jun 19 [Epub ahead of print]
• the authors conclude that the effectiveness of resiniferatoxin in the treatment of interstitial cystitis remains unknown
What is new in bladder pain syndrome/interstitial cystitis? Hanno P, Nordling J, van Ophoven A. Curr Opin Urol 2008;18:353-8
• in this review the authors bring practicing healthcare providers up to date with the literature on bladder pain syndrome/interstitial cystitis, and the implications for their patients
Cyclosporine A in the treatment of interstitial
cystitis. Jukka Sairanen. Academic dissertation, University of Helsinki, Finland, 25 January 2008 • the author concludes that cyclosporin A is a viable treatment option in patients with PBS/IC who fulfil the
NIDDK criteria and have serious symptoms and in whom previous attempts to alleviate
symptoms have failed; the author also concludes that his results support the need for future clinical studies with drug
compounds that modulate inflammation in PBS/IC bladder.
Quantifying mast cells in bladder pain syndrome by immunohistochemical analysis. Larsen MS, Mortensen S, Nordling J, Horn T. BJU Int 2008 Apr 2 [Epub ahead of print] • the purpose of this study was to evaluate a simple method for counting mast cells as the current enzymatic staining method (naphtolesterase) on 10 µm sections for quantifying mast cells is complicated
• in the present study, 61 patients had detrusor biopsies and were given a clinical score; sections of the biopsy were stained with (i) naphtolesterase on 10 µm sections, staining every third section, or (ii) immunohistochemically with antitryptase on both 10 µm and 3 µm sections, with two and six unstained sections between, respectively
• the old and the new methods, on 10 and 3 µm sections, showed a good correlation between mast cell counts; when using tryptase staining and 3 µm sections, the mast cell number correlated well with the clinical score (Spearman's rho 0.576; 95% confidence interval 0.155-0.820) and 27 mast cells/mm(2) was the threshold suggesting mastocytosis
• the authors recommend taking biopsies from the detrusor of patients with suspected BPS and examining them with tryptase-stained 3 µm thick sections, with every seventh section used for quantification; 27 mast cells/mm(2) is considered indicative of mastocytosis
Characterization of a clinical cohort of 87 women with interstitial cystitis/painful bladder syndrome. Peters KM, Carrico DJ, Diokno AC. Urology 2008;71:634-40 • the described population of women with unrelieved chronic pain, frequency, and urgency is in desperate need of care.
• the authors conclude that it may be most therapeutic to develop a multimodal plan of care that includes physical therapy, oral and intravesical therapies, neuromodulation, and cognitive-behavioral therapies
Evidence-based criteria for pain of
interstitial cystitis/painful bladder syndrome in women. Warren JW, Brown J, Tracy JK et al. Urology 2008;71:444-8
• in this Events Preceding Interstitial Cystitis study, pain that
-
worsened with a certain food or
drink, and/or
-
worsened with bladder filling, and/or
- improved with urination
was reported by 151
(97%) of 156 patients; these were the only three criteria that applied directly to the bladder
• the same three criteria described the pain of 262 (97%) of 270 women in the Interstitial Cystitis
Database who “definitely” had IC/PBS • the authors conclude that this triad might
describe the pain of IC/PBS and contribute to a sensitive case definition
Time to initiation of pentosan polysulfate sodium treatment after interstitial cystitis diagnosis: effect on symptom improvement. • this is a retrospective analysis in patients who had been treated with PPS 300 mg/day for 32 weeks in a multi-center, randomized, double-blind, parallel-group clinical trial Nickel JC, Kaufman DM, Zhang HF, et al. Urology 2008;71:57-61
• initiation of PPS treatment within 6 months of establishing the diagnosis of IC may be associated with greater improvement in patient symptoms and symptom bother than treatment initiation 24 months or more after IC diagnosis
Followup of patients with interstitial cystitis responsive to treatment with intravesical bacillus Calmette-Guerin or placebo. Propert KJ, Mayer R, Nickel JC, et al. J Urol 2008;179:552-5 • most patients who respond to therapy with intravesical BCG or placebo maintain improved symptoms for up to 68 weeks after the initiation of therapy; however, initial response rates are low and placebo responders demonstrated essentially the same durability of response as BCG responders
• the authors conclude that these results argue against the routine use of BCG in this patient group
Patient perceived outcomes of treatments used for interstitial cystitis. Hill JR, Isom-Batz G, Panagopoulos G, et al. Urology 2008;71:62-6 • 750 patients with a diagnosis of IC completed a computerized survey that queried each patient about their demographics, symptoms, concomitant diagnoses, treatments, and their perceived treatment outcomes
• the authors conclude that medical therapy is perceived to be superior to invasive therapy in the treatment and that several medications showed a large percentage of patients with improvement in symptoms
• these medications were calcium glycerophosphate, phenazopyridine and pentosan polysulfate sodium
comment: this study may be biased as the survey was a direct link from 3 websites, one of them being a commercial site
Hyaluronan treatment of interstitial cystitis/painful bladder syndrome. Riedl CR, Engelhardt PF, Daha KL, Morakis N, Pflüger H. Int Urogynecol J Pelvic Floor Dysfunct 2007 Dec 21 [Epub ahead of print] • this study evaluated the efficacy of intravesical hyaluronan therapy in 126 patients with IC/PBS and mean disease duration of 6.1 years; to be eligible for hyaluronan treatment, a positive modified potassium test was requested as a sign of a urine-tissue barrier disorder • patients were treated with weekly instillations of a 50 ml phosphate-buffered saline solution containing 40 mg sodium hyaluronate
• data were obtained by a visual analogue scale (VAS) questionnaire rating from 0 to 10 that asked for global bladder symptoms before and after therapy; additional questions evaluated the therapeutic impact on quality of life.
• 85% of the patients reported symptom improvement (2 or more VAS units); the mean initial VAS score of 8.5 decreased to 3.5 after therapy (p<0.0001); 55% remained with no or minimal bladder symptoms after therapy (VAS 0-2); 84% reported significant improvement of their quality of life
• intravesical therapy had to be initiated again with good success in 43 patients (34.5%) as symptoms recurred after discontinuation of treatment, while the rest stayed free of symptoms for up to 5 years
• in general, hyaluronan therapy was well tolerated and, with the exception of mild irritative symptoms, no adverse reactions were reported for a total of 1,521 instillations
• the authors conclude that timely hyaluronan instillation therapy may lead to complete symptom remission or even cure in part of the IC/PBS patients, while some responders need continuous intravesical therapy
• the present results suggest that selection of patients for hyaluronan therapy by potassium testing improves the outcome of intravesical therapy with a response rate of >80%
Re-imagining interstitial cystitis. Hanno PM. Urol Clin North Am 2008;35:91-9 • a review of the history of criteria and disease names down to the ESSIC proposal
Intravesical treatments for painful bladder syndrome/ interstitial cystitis. Dawson T, Jamison J. Cochrane Database Syst Rev 2007 Oct 17;(4):CD006113
• the authors conclude that the evidence base for treating PBS/IC using intravesical preparations is limited
• the quality of trial reports was mixed and in some cases this precluded any meaningful data extraction
• BCG and oxybutin are reasonably well-tolerated and evidence is most promising for these
• resiniferatoxin showed no evidence of effect for most outcomes and caused pain, which reduced treatment compliance
• there is little evidence for the other treatments included in this review
Effect of Comestibles on Symptoms of Interstitial Cystitis.
Shorter B, Lesser M, Moldwin RM, Kushner L. J Urol 2007 May 10; [Epub ahead of print] • patients with painful bladder syndrome/interstitial cystitis 90.2% indicated that the consumption of certain foods or beverages caused symptom exacerbation • there was no correlation between allergies and the effect of comestibles on symptoms
• the most frequently reported and most bothersome comestibles were coffee, tea, soda, alcoholic beverages, citrus fruits and juices, artificial sweeteners and hot pepper
Ketamine-Associated Ulcerative Cystitis: A New Clinical Entity. Shahani R, Streutker C, Dickson B, Stewart RJ. Urology 2007;69:810-2 • ketamine is an anesthetic agent that is increasingly being used as a recreational drug
• the authors describe a series of 9 patients, all of whom were daily ketamine users, who presented with severe dysuria, frequency, urgency, and gross hematuria; the urine cultures were sterile in all cases
• CT revealed marked thickening of the bladder wall, a small capacity, and perivesicular stranding, consistent with severe inflammation; at cystoscopy, all patients had severe ulcerative cystitis.
• biopsies in 4 patients revealed epithelial denudation and inflammation with a mild eosinophilic infiltrate
• cessation of ketamine use, with the addition of pentosan polysulfate, appeared to provide some symptomatic relief
The Fibromyalgia Bladder Index. Brand K, Littlejohn G, Kristjanson L, et al. Clin Rheumatol. 2007 May 3; [Epub ahead of print] • the aim of this study was to determine whether the Interstitial Cystitis Symptom and Problem Index (ICSI/ICPI), is a valid, reliable, and clinically relevant instrument to assess the sensory urinary symptoms in women with fibromyalgia syndrome (FM)
• factor analysis displayed two separate components of symptom and problem combinations as distinct from the original ICSI/ICPI developed for the interstitial cystitis population
• the eight items of the index configured differently and formed two subscales of a newly developed Fibromyalgia Bladder Index
• the two subscales of this index include the Bladder Urgency and Pain Subscale and the Bladder Frequency and Nocturia Subscale.
Interstitial cystitis and female sexual dysfunction. Ottem DP, Carr LK, Perks AE, et al. Urology 2007;69:608-10
• the authors conclude that female patients with IC have sexual dysfunction, including pain, more commonly than do controls
EEC syndrome, Arg227Gln TP63 mutation and micturition difficulties: Is there a genotype-phenotype correlation? Maclean K, Holme SA, Gilmour E, et al. Am J Med Genet A 2007 Apr 12; [Epub ahead of print] • case report on two unrelated families with EEC syndrome (ectrodactyly, ectodermal dysplasia, cleft lip/palate), each with an Arg227Gln TP63 gene mutation
• features common to both families were an ectodermal dysplasia principally affecting tooth, breast and nipple development, dacryostenosis and severe micturition difficulties; additional findings included post-axial digital hypoplasia, cleft uvula, anal stenosis, hypoplasia of the perineal body and biopsy-proven interstitial cystitis
• unlike previous reports, the urinary symptoms were refractory to treatment with oral Fibrase and persisted into adulthood
• of the 6 cases/families now reported with EEC syndrome and Arg227Gln TP63 mutation, 4 have manifested this distinct urological abnormality, indicative of a genotype-phenotype correlation
Diagnosis of interstitial cystitis/ painful bladder syndrome in patients with overactive bladder symptoms. Macdiarmid SA, Sand PK. Rev Urol 2007;9:9-16 • overactive bladder (OAB) and interstitial cystitis (IC) have similar symptoms, including urinary urgency/frequency and nocturia, making them difficult to differentiate on the basis of clinical presentation alone
• the authors propose a diagnostic framework that may be useful for differentiating IC from OAB and for facilitating appropriate treatment
Prevalence of painful bladder symptoms and effect on quality of life in black, hispanic and white men and women. Clemens JQ, Link CL, Eggers PW, et al. J Urol 2007;177:1390-4 • a population based cross-sectional survey of 5506 individuals was done in the Boston area for symptoms of painful bladder symptoms (PBS, based on consensus statements, research definitions and published articles) • the prevalence of PBS symptoms was 0.83-2.71% in women and 0.25-1.22% in men depending on the definition used; the presence of symptoms was associated with a significant adverse impact on quality of life • the findings indicate no racial/ethnic disparity and limited gender disparity in the prevalence of PBS symptoms
Bilateral s3 stimulator in patients with interstitial cystitis. Steinberg AC, Oyama IA, Whitmore KE. Urology 2007;69:441-3
• this retrospective study demonstrated that 15 patients diagnosed with interstitial cystitis with the symptoms of frequency, urgency, and pain had a significant decrease in frequency and nocturia with bilateral stimulator placement
Assessing urgency in interstitial cystitis/painful bladder syndrome. Diggs C, Meyer WA, Langenberg P, et al. Urology 2007;69:210-4 • the O'Leary-Sant Symptom Index appeared to underreport urgency
• asking about urgency "with little or no warning" underestimated the prevalence and degree of urinary urgency
• the authors conclude with the question that may have pathophysiological importance: "why do patients with IC/PBS have urgency ?"
RANTES mediates TNF-dependent lamina propria mast cell accumulation and barrier dysfunction in neurogenic cystitis. Chen MC, Keshavan P, Gregory GD, Klumpp D. Am J Physiol Renal Physiol 2007 Jan 23; [Epub ahead of print]
• this study shows that RANTES plays a key role in the pathogenesis of neurogenic cystitis and suggest that chemokines may represent novel therapeutic targets for IC patients with mast cell-associated disease
(webmaster's comment: RANTES, an acronym for Regulated on Activation - Normal T Expressed and Secreted, is a cytokine that attracts a particular subset of T-lymphocytes and monocytes)
Symptoms of interstitial cystitis, painful bladder syndrome and similar diseases in women: a systematic review. Bogart LM, Berry SH, Clemens JQ. J Urol 2007;177:450-6 • for the purpose of development of a case definition for IC in women, the authors performed a systemic literature review of symptoms of IC, PBS, vulvodynia, pelvic floor dysfunction, overactive bladder, urethral syndrome, various presentations of urinary infections, incontinence (not stress) and various presentations of endometriosis
• the authors conclude that in terms of symptoms:
-
IC and PBS may be the same entity; recurrent urinary tract infections may be distinguished from IC and PBS via a combination of self-report and urine culture information
- IC and PBS may be distinguished from OAB, vulvodynia and endometriosis, although
identifying IC and PBS in women with more than 1 of these diseases may be difficult
The dual serotonin and noradrenaline reuptake inhibitor duloxetine for the treatment of interstitial cystitis: results of an observatinal study. van Ophoven A, Hertle L.J Urol 2007;177:552-5
• in this observational study, duloxetine was given for two months to 48 women with IC according to the NIDDK criteria
• 5 patients (10.4%) responded and 17 (35.4%) dropped out due to nausea as a side effect
• patients who responded reported onset of improvement but not until they had reached the target dose of 2x 40 mg per day
• the authors conclude that
duloxetine did not result in significant improvement of symptoms in patients with IC
not new but important for the discussion on confusable diseases: Dysuria and a headache. Lo S, Noble J, Bowler I, Angus B. Lancet 2004;364:1554 • a case report of a 49-year-old white woman with symptoms of recurrent urinary tract infections; she had no other medical history of note and she had not traveled outside of the UK
• an initial diagnosis of interstitial cystitis was found to be wrong; despite she had no pulmonary disease, the cystitis was found to be due to infection with Mycobacterium tuberculosis
Interstitial cystitis in a woman with systemic mastocytosis. Roth TM. Int Urogynecol J Pelvic Floor Dysfunct 2006 Nov 24; [Epub ahead of print]
• the author describes a patient with systemic mastocytosis who was confirmed to have detrusor mastocytosis and interstitial cystitis
Interleukin-6, histamine, and methylhistamine as diagnostic markers for interstitial cystitis. Lamale LM, Lutgendorf SK, Zimmerman MB, Kreder KJ. Urology 2006;68:702-6
• the authors conclude that a combination of methylhistamine and IL-6 could be used as a sensitive and specific marker for interstitial cystitis; however, the sensitivity of 70.0% and specificity of 72.4% do not seem good enough for their use in clinical practice
Mast cells are essential intermediaries in regulatory T-cell tolerance. Lu LF, Lind EF, Gondek DC, et al. Nature 2006;442:997-1002 • the results show that contrary to the proinflammatory role of mast cells in allergic disorders, mast cells are essential in regulatory T-cell dependent peripheral tolerance
• this papermay form the basis for understanding why mast cells are located in very specific sites within tissues
The molecular basis of urgency: Regional difference of vanilloid receptor expression in the human urinary bladder. Liu L, Mansfield KJ, Kristiana I, et al. Neurourol Urodyn 2006 Oct 2; [Epub ahead of print]
• the authors conclude that symptoms of sensory urgency were associated with the increased expression of targeting vanilloid receptor TRPV1 mRNA in the trigonal mucosa; no upregulation or regional differences of TRPV1 mRNA were seen in idiopathic detrusor overactivity patients
• TRPV1 may play a role in SU and premature first bladder sensation on filling
Prevalence and Correlates for Interstitial Cystitis Symptoms in Women Participating in a Health Screening Project. Temml C, Wehrberger C, Riedl C, et al. Eur Urol 2006 Aug 30; [Epub ahead of print]
• the prevalence of IC in an urban female population was 306/100,000 women
• bowel disorders and psychological stress were correlated to the probability of IC
• the authors conclude that the prevalence of IC symptoms is higher than previously estimated and substantially affects quality of life and sexuality.
Dysuria at onset of interstitial cystitis/painful bladder syndrome in women.
Warren JW, Diggs C, Brown V, et al. Urology 2006 Sep 15; [Epub ahead of print]
• a slight majority of women with IC/PBS reported dysuria at onset of their IC/PBS symptoms
• the available laboratory data have suggested that dysuria may be a sensitive indicator of urinary tract infection at the onset of IC/PBS; however, its specificity is as yet undetermined.
Oral presentations at the 31st Annual IUGA Meeting, Athens, Greece, 6-9 September 2006
abstract 046
There is a low incidence of recurrent bacteriuria in painful bladder syndrome/interstitial cystitis (PBS/IC) patients followed longitudinally. Stanford EJ, McMurphy C. Int Urogynecol J 2006;17(Suppl 2):S85
• the authors conclude that only a small number of PBS/IC patients with UTI symptoms have a positive urine culture (9.4%); the incidence of recurrent UTI is 6.6%
abstract 048
Reducing interstitial cystitis pain via pelvic floor electrostimulation. de Jong P, Radziszewski P, Dobronski P, et al. Int Urogynecol J 2006;17(Suppl 2):S86
• the authors conclude that a significant effect of pelvic floor stimulation (Miniaturo™-1) in pain associated with IC/PBS was demonstrated
• improving this distressing parameter considerably changed the quality of life of the patients
Development of glomerulations in younger women with interstitial cystitis. Shear S, Mayer R. Urology 2006;68:253-6
• the authors conlude that
- interstitial cystitis symptoms can develop before an age where adult urologists or primary care physicians familiar with the diagnosis and treatment are usually involved with care
- the cystoscopic appearance of the bladder wall after hydrodistension may not be constant over time, and that the absence of initial findings of glomerulations or terminal hematuria does not preclude further development of these hallmarks of the disease on subsequent evaluation
Cysteinyl leukotriene D4 increases human detrusor muscle responsiveness to histamine. Bouchelouche K, Bouchelouche P. J Urol 2006;176:361-6 • in this study, it is shown that leukotriene D4 potentiates the effect of histamine in the human detrusor muscle.
• leukotriene D4 and histamine, that are often released concomitantly from mast cells, may interact mutually to potentiate the spasmogenic effect of histamine
• these authors suggest that the combination of leukotriene D4 and histamine H1 receptor antagonists may be more effective for the treatment of interstitial cystitis than when given alone
Transient receptor potential vanilloid receptor subtype 1 in painful bladder syndrome and its correlation with pain. Mukerji G, Yiangou Y, AgarwalSK, Anand P. J Urol 2006;176:797-801
• this study shows increased transient receptor potential vanilloid receptor subtype 1 in nerve fibers of the bladder in painful bladder syndrome and a correlation of the pain score with the relative density of transient receptor potential vanilloid receptor subtype 1 nerve fibers
• the authors conclude that transient receptor potential vanilloid receptor subtype 1 may have a role in the pathophysiology of painful bladder syndrome and it is a potential target for novel therapeutic agents
Efficiency of Questionnaires Used to Screen for Interstitial Cystitis. Kushner L, Moldwin RM. J Urol 2006;176:587-92
• the Pain, Urgency, Frequency Symptom Scale and the O’Leary-Sant Symptom Index and Problem Index were administered to the same 220 patients at a urology clinic before diagnosis
• IC was distinguishable from the other diagnoses using both questionnaires (p<0.001)
• separate analyses of bother and symptom scores yielded similar results
• ROC curves demonstrated the Pain, Urgency, Frequency Symptom Scale to be more efficient than the O’Leary-Sant Symptom Index and Problem Index in detecting interstitial cystitis in this population with an optimal cutoff value of 13 or greater
• the authors conclude that while the Pain, Urgency, Frequency Symptom Scale and the O’Leary-Sant Symptom Index and Problem Index questionnaires distinguish interstitial cystitis from other urinary tract pathologies, neither questionnaire demonstrates sufficient specificity to serve as the sole diagnostic indicator; and further that these questionnaires should not be used to define IC, but can be used to screen patients with urinary tract symptoms to identify those who should be further examined for IC or to follow those who have already been diagnosed
comment:
• only the combined symptoms in the scale and index scores were analysed and not the separate symptoms e.g. pain related to the bladder
Using the International Continence Society's definition of painful bladder syndrome. Warren JW, Meyer WA, Greenberg P, et al. Urology 2006;67:1138-42; discussion 1142-3
• the authors conclude that the ICS definition identified only 91 (66%) of the 138 patients whom study investigators and caregivers diagnosed as having IC/PBS
• furthermore, those who met the ICS definition did not differ in important ways from those who did not
• these observations suggest that the ICS definition may not be sufficiently sensitive; minor modifications of the definition appeared to increase its sensitivity
Clinical aspects and surgical treatment of urinary tract endometriosis: our experience with 31 cases. Antonelli A, Simeone C, Zani D, et al. Eur Urol 2006;49:1093-8. Epub 2006 Apr 4 • the authors conclude that cystoscopy is advisable in women with pelvic endometriosis with lower urinary tract symptoms
• in their hands, partial cystectomy gave the best results when used to treat bladder endometriosis
editorial comment: "Bladder involvement presents with irritative symptoms in more than 70% of patients, which indicates that this condition should be part of the differential diagnosis of interstitial cystitis"
Chondroitin sulfate for interstitial cystitis. Palylyk-Colwell E. Issues Emerg Health Technol 2006 May;(84):1-4
• this review concludes that two non-randomized, uncontrolled pilot studies reported improvements in patient-reported symptoms after the use of chondroitin sulfate for one year
• the author also concludes that prospective, randomized, head-to-head trials are needed to assess the effectiveness of this technology compared with other IC therapies
Lower urinary tract symptoms in female patients with rheumatoid arthritis. Lee KL, Chen MY, Yeh JH, et al. Scand J Rheumatol 2006;35:96-101
• patients with RA were found to have similar urinary complaints when compared to controls; however, those with secondary SS had a greater severity of lower urinary tract symptoms, a finding similar to that observed in patients with primary SS
Urothelial lesion formation is mediated by TNFR1 during neurogenic cystitis. Chen MC, Mudge CS, Klumpp D. Am J Physiol Renal Physiol 2006 Apr 18; [Epub ahead of print] • the authors conclude that mast cell activation and release of TNF drives urothelial apoptosis and lesion formation in a murine neurogenic cystitis model, and they hypothesize that anti-TNF therapy may stabilize bladder barrier function in IC patients
Efficacy of interstitial cystitis treatments: a review. Karsenty G, AlTaweel W, Hajebrahimi S, Corcos J. EAU-EBU Update Series 2006;4:47-61 • in this article, the degree of evidence regarding the clinical efficacy of available interstitial cystitis treatment options is reviewed • only three therapies are supported by a high level of evidence: oral cimetidine and amitriptyline and the intravesical dimethylsulfoxide (DMSO)
Interstitielle Zystitis
Eine wichtige Differentialdiagnose [Interstitial cystitis An important differential diagnosis.] [Article in German] van Ophoven A, Oberpenning F. Urologe A 2006 Mar 14; [Epub ahead of print] - a review on interstitial cystitis in German
Cool and menthol receptor TRPM8 in human urinary bladder disorders and clinical correlations. Mukerji G, Yiangou Y, Corcoran SL, et al. BMC Urol 2006 Mar 6;6(1):6 [Epub ahead of print]
- according to the authors, this study demonstrates increased cold-menthol sensory receptors (TRPM8) in nerve fibres of overactive and painful bladders, and its relationship with clinical symptoms; they suggest that TRPM8 may play a role in the symptomatology and pathophysiology of these disorders, and may provide an additional target for future overactive and painful bladder pharmacotherapy
Keratin expression profiling of transitional epithelium in the painful bladder syndrome/interstitial cystitis.
Laguna P, Smedts F, Nordling J, et al. Am J Clin Pathol 2006;125:105-10
• bladder urothelium in PBS/IC showed distinct differences in the profiles of keratins 7, 8, 14, 17, 18, and 20 compared with literature reports for normal bladder urothelium; whether these changes are primary or secondary to another underlying condition remains to be determined according to the authors note:
• PBS/IC patients fulfilled the NIDDK criteria
• keratins, of which 20 types are known, are the most important parts of the skeleton of the cell
Predictors of symptom severity in patients with chronic prostatitis and interstitial cystitis. Clemens JQ, Brown SO, Kozloff L, Calhoun EA. J Urol 2006;175:963-7 • few common medical conditions were predictive of symptoms severity in this analysis; self-reported pelvic pain symptoms, education and depression severity were the factors most strongly predictive of symptom severity in patients with CP/CPPS and IC
Interstitial
cystitis: cost, treatment and co-morbidities in an employed
population.
Wu EQ, Birnbaum H, Mareva M, et al. Pharmacoeconomics.
2006;24:55-65
• the authors conclude that:
- IC is a costly disease associated
with co-morbidities
- following diagnosis, patients with IC are commonly untreated
or treated with non-approved drug therapies
- it is possible that more accurate diagnosis
and earlier and more appropriate treatment of IC would lead to
better management (or even prevention) of co-morbidities and
reduce healthcare costs, and this should be investigated in future
studies.
A novel highly effective treatment of interstitial cystitis causing chronic pelvic pain of bladder origin: case reports. Check JH, Katsoff B, Citerone T, Bonnes E. Clin Exp Obstet Gynecol 2005;32:247-9
• two women with interstitial cystitis that had been refractory to various therapies were treated with dextroamphetamine sulfate
• both patients quickly improved their bladder symptoms, all pain and urgency was gone within a week and the IC remission as long as the women stayed on their medication
Symptoms and cystoscopic findings in patients with untreated interstitial cystitis.
Lamale LM, Lutgendorf SK, Hoffman AN, Kreder KJ. Urology 2006 Jan 24; [Epub ahead of print]
• in patients with untreated interstitial cystitis, a strong correlation between pain and cystoscopic findings was observed
• the authors explain the differences between their results and those of previous studies (that found no relationship between symptom reports and cystoscopic findings) by possible effects of treatment on pain perception and therapeutic influence on cystoscopic findings
The management of interstitial cystitis: an update. Phatak S, Foster HE. Nat Clin Pract Urol 2006, 3:45-53 • this review aims to cover standard and novel treatment options, while concentrating on the management of pain
A
simple method for teaching about voiding disorders. Steers WD, Gray M. BJU Int 2006;97:237-42 • the authors describe the binomial-type
system that they developed to provide a simple conceptualization
of pathophysiology and treatment strategies for disorders of
the lower urinary tract
Responsiveness
of symptom scales for interstitial cystitis. Propert KJ, Mayer RD, Wang Y, et al. Urology
2006;67:55-9
• the three symptom scales (O'Leary-Sant Symptom and Problem
Indexes, University of Wisconsin Interstitial Cystitis Inventory
and scales that measure individual symptom domains of pain/discomfort,
urgency, and voiding frequency) are responsive to change over time
in patients with
IC
• the authors conclude that these indexes provide important
insight into symptom changes and recommend them as secondary endpoints
in future clinivcal trials of IC
Interstitial
cystitis versus detrusor overactivity: a comparative, randomized,
controlled study of cystometry using saline and 0.3 m potassium
chloride. Philip J, Willmott S, Irwin P. J Urol 2006;175:566-71 • the authors compared cystometric findings in interstitial cystitis (IC)
and detrusor overactivity (DO) using 0.3 M KCl and 0.9% normal saline
• they conclude that
(1) the 0.3 M KCl reduces Cmax in IC and DO, (2) the effect being
more pronounced in DO, (3) urothelial hyperpermeability is not specific to IC
and that (4) comparative cystometry using NS and 0.3 M KCl does not help to differentiate
IC from DO
Interstitial cystitis and infectious agents. Fioriti D, Penta M, Mischitelli M, et al. Int J Immunopathol Pharmacol 2005,18:799-804 • in this case report a 42-year old women with IC is described in whom bladder biopsies revealed a viral co-infection; the authors suggest that this finding could support the hypothesis of a multi-factorial origin of IC. pathology
Chronic pelvic pain: the occurrence of interstitial cystitis in a gynecological population. Paulson JD, Delgado M. JSLS 2005;9:426-30 35 women with chronic pelvic pain underwent laparoscopy and cystoscopy with hydrodistention; 28 patients (80%) were diagnosed with interstitial cystitis, 28 with endometriosis (80%), 24 had both diseases {69%), and 32 (91%) had endometriosis, interstitial cystitis, or both. Three patients (9%) had neither and were diagnosed with other pathologies
Risk
factors for painful bladder syndrome in women seeking gynecologic
care. Kennedy CM, Bradley CS, Galask RP, Nygaard IE. Int Urogynecol
J 2005;17:73-8 • in this survey among 645 women seeking
gynaecologic care, bladder pain was associated with current smoking,
irritable bowel syndrome and a generalized pain disorder
