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Zusammenfassung Die interstitielle Zystitis (IC) ist eine chronisches, heterogenes Syndrom, das mit den klassischen Symptomen Nykturie, Pollakisurie und Blasenschmerzen einhergeht. Populationsstudien zeigen ansteigende Prävalenz- und Inzidenzraten. Von den unterschiedlichen Hypothesen zur Pathogenese und Ätiologie werden die der epithelialen Dysfunktion und der neurourothelialen Wechselwirkung am häufigsten zur Erklärung genutzt. Es empfiehlt sich eine individuelle und flexible Anwendung der offiziellen Diagnosekriterien des NIDDK (National Institute of Diabetes, Digestive and Kidney Disease), um gut therapierbare Frühformen nicht zu übersehen. Da ein pathognomonischer Marker noch fehlt, beruht die Diagnose v. a. auf klinischen Befunden und dem Ausschluss von Differenzialdiagnosen. Blasenspiegelung und Probebiopsie sind nicht beweisend, machen die Diagnose jedoch wahrscheinlicher und können wichtige Informationen über den Ausprägungsgrad, auch in Hinblick auf eine angepasste Therapie, liefern. Die elektromotorische Medikamentenapplikation (EMDA) in der Instillationstherapie hat in den letzten Jahren die Erfolgsraten der konservativen Therapie deutlich verbessert. 相似文献
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Ohne Zusammenfassung 相似文献
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Kliesch S 《Der Urologe. Ausg. A》2000,39(6):527-529
Available data on the epidemiology of interstitial cystitis (IC) are heterogeneous. Its prevalence ranges between 16 and 510 females/100,000 inhabitants and the incidence at 1.2-2.6/100,000 females with a mean age of 42-52 years. The disease tends to affect women (female:male ratio 9-10:1) and Caucasians (> 90%). The quality of life of patients suffering from IC is reduced to a significant degree in almost every aspect (work, social events, leisure activities). Financial expenses (medical as well as economical) associated with the disease are considerable. There is an enormous need to promote IC education and research in order to support affected patients effectively in the future. 相似文献
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S. Kliesch 《Der Urologe. Ausg. A》2000,4(3):527-529
Die vorliegenden Daten zur Epidemiologie der interstitiellen Zystitis sind sehr heterogen. Die Pr?valenz betr?gt 16–510 Frauen/100.000 Einwohner, die Inzidenz liegt zwischen 1,2–2,6 /100.000 Frauen mit einem mittleren Alter bei Diagnosestellung von 42–52 Jahren. Die Geschlechterverteilung bevorzugt das weibliche im Verh?ltnis zum m?nnlichen Geschlecht (9–10 Frauen/1 Mann) mit einer ethnischen Bevorzugung der Kaukasier (>90%). 相似文献
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We present a rare case of cystitis emphysematosa in an 85-year-old female patient in whom the typical risk factors were present: diabetes of long standing, neurogenic bladder and urinary infection with E.coli. Thanks to early diagnosis by cystoscopy and abdominal CT, after antibiotic treatment, appropriate insulin therapy and continuous bladder drainage the course was uneventful. The patient was fit to leave hospital after 14 days. 相似文献
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Interstitial cystitis (IC) represents a rare and complex inflammatory bladder condition in which diagnostics can be challenging. Strict NIH criteria for its diagnosis were designed for research purposes. Their routine application would miss large proportions of IC patients. When IC is suspected, history and physical exam are followed by an evaluation of long-term voiding diaries. Large voided volumes (functional capacity > 250 cc) or longer micturition intervals (> 2 h.), absence of nocturia or symptom-free periods reduce the likelihood of IC. Further exclusion diagnostics include urine tests (infection), cytology (in-situ carcinoma), ultrasound (calculi, bulks, anomalies) and urodynamics in selected cases. Bladder capacity measurements under sedoanalgesia are of limited value, since functional low-volume bladders can be mechanically extendable. Cystoscopy under general anesthesia represents the diagnostic standard procedure for IC during which 90% of IC-patients present with characteristic mucosal glomerulations after bladder distension. Biopsies are recommended for exclusion of malignancy. Potassium-leak testing plays no relevant role in routine diagnostics due to its poor sensitivity. Similarly, complex determinations of novel IC markers (histamine, tryptase, cytokines, growth factors, substance P, nitric oxide) are of no relevance in clinical settings and should be restricted to research projects. 相似文献
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Die Behandlung der interstitiellen Zystitis (IC) stellt eine der schwierigsten therapeutischen Herausforderungen in der Urologie dar. Zahlreiche Urologen sind der Ansicht, dass ein konservativer Therapieansatz bei den leidenden Patienten nicht l?nger hinausgez?gert werden sollte, da effektive chirurgische Alternativen zur Verfügung stehen, die eine schnelle und anhaltende Linderung zu erzielen verm?gen. 相似文献
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Endourological surgical procedures (transurethral resection and fulguration, Nd-YAG-laser application) for the treatment of interstitial cystitis (IC) have been evaluated only in a few studies. Theoretically, they could be the next step in a therapeutic concept after conservative measures have failed and before open surgery is performed as an ultima ratio. However, our review of the literature suggests that to date there is no scientific evidence to support endourological techniques in the treatment of IC. 相似文献
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Endourologische Operationstechniken (transurethrale Resektion und Koagulation, Nd-YAG-Laser) zur Behandlung der interstitiellen Zystitis (IC) wurden nur in wenigen Studien wissenschaftlich untersucht. Nach Aussch?pfen konservativer Behandlungsstrategien stellen sie theoretisch den n?chsten Schritt im Therapiekonzept dar, bevor offen chirurgische Behandlungsans?tze als Ultima ratio zum Einsatz kommen. 相似文献
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Treatment of IC is one of the most difficult therapeutic challenges in urology, frequently resulting in frustration for both patient and therapist. Many urologists believe that conservative treatment should not be unnecessarily prolonged in severe cases with low bladder capacity, since cystectomy may provide immediate and permanent relief for the suffering patient. However, it remains unclear which surgical approach and technique is the most suitable. Generally three different techniques are performed: supratrigonal cystectomy; radical cystectomy, saving only the bladder neck; and, finally, radical cystectomy combined with excision of the urethra. All three techniques require substitution of the excised bladder tissue with bowel segments. 相似文献
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Die intravesikale Instillationstherapie hat den Vorteil einer hohen Wirkkonzentration in der Blase bei geringen systemischen Nebenwirkungen. Pentosanpolysulfat wird relativ h?ufig zur Blaseninstillation eingesetzt und senkt signifikant die Nykturiefrequenz, w?hrend die Miktionsfrequnz tagsüber in einer kontrollierten Studie unver?ndert blieb. Auch Heparin senkte die Nykturiefrequenz in einer offenen prospektiven Studie. Der maximale Wirkungseintritt wird bei Heparin oft erst nach 4–6 Monaten bemerkt. Sowohl Heparin als auch Pentosanpolysulfat sind praktisch nebenwirkungsfrei. 相似文献
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Up to now there is no specific treatment targeting the ultimate cause of interstitial cystitis (IC), since its pathogenesis and etiology are still unknown. Most studies focussing on oral medication have not been randomized, double-blinded or placebo-controlled. Numerous case reports and intent-to-treat trials are lacking a systematic approach and do not meet evidence-based medicine criteria. Consequently there is as yet no standard oral therapy available for the treatment of IC. However, only a few oral substances have shown a potential to improve symptoms such as frequency and pain. The best results were obtained from monotherapeutic use of pentosanpolysulfate, amitriptylin and hydroxycin. The true benefit of these substances alone should be compared to analgesics and anticholinergics in the course of controlled clinical trials. 相似文献
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Intravesically applied medications have the benefit of establishing high concentrations of a therapeutic agent at the intended target tissue along with a low risk for systemic side effects. Pentosanpolysulfate is frequently applied for this purpose and was shown to significantly reduce nycturia while frequency during the day remained unaffected in a controlled study. Heparin reduced nycturia in an open prospective protocol as well. For heparin the maximal onset of a therapeutic effect is often observed as late as 4-6 months after initiation of treatment. Heparin as well as pentosanpolysulfate cause practically no side effects. Dimethylsulfoxide (DMSO), when instilled intravesically, decreases symptoms up to 50-70% for an effective period of 1-2 months. An irritating but harmless side effect of DMSO is the development of a striking garlic-like odor. BCG improved symptoms in 10 of 15 patients after 8 months and in 8 of 15 patients after 24 months. No patient with an initial bladder capacity below 175 cc benefited from BCG instillations. Discomfort in the bladder region was noted as a frequent side effect. Instillations of clorpactin WCS 90 are painful and can thus only be applied under anesthesia. Success rates range between 50-70% and last for 6-12 months. 相似文献
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Dr. med. H. Schröder Dr. med. K. -G. Voigt 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》1965,310(3):257-266
Zusammenfassung Bei weißen Ratten wurde experimentell ein Verschluß des Ductus choledochus herbeigeführt, was teilweise mit und teilweise ohne gleichzeitige Obstruktion des Bauchspeichelabflusses erfolgte. In beiden Fällen ließ sich am Pankreas das Auftreten einer Sekretstase mit interstitieller Entzündung beobachten.Die Pathogenese der interstitiellen Pankreatitis wird an Hand der Versuchsergebnisse diskutiert. Für die Klinik ergibt sich aus den Tierexperimenten die Folgerung, daß bei Gallengangsverschlüssen—auch ohne zusätzliche Verlegung der Abflußwege des Bauchspeichels—häufiger Veränderungen des Pankreas vorkommen können, als allgemein angenommen wird.Mit 6 Textabbildungen 相似文献
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Alternative therapies are gaining more and more popularity. Mostly, these methods are demanded by patients who are not effectively relieved by allopathy. This review points out alternative and additive methods that have been repeatedly described as effective as additional supportive treatments of interstitial cystitis. 相似文献
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