Improvement of interstitial cystitis symptoms and problems that developed during treatment with oral IPD-1151T

PURPOSE: We examined the efficacy of Suplatast Tosilatedouble dagger (IPD-1151T), a new immunoregulator that suppresses helper T cell mediated allergic responses, including IgE production and eosinophilic inflammation for treating patients with interstitial cystitis. MATERIALS AND METHODS: A total of 14 women (average age 43.7 years) with interstitial cystitis, which was nonulcerative in 13 and ulcerative in 1, were treated with 300 mg. IPD-1151T orally daily for 12 months. All patients received laboratory assessments, including hematology (eosinophils and CD20 positive cells) and serum chemistry (IgE, and interleukin-4 (IL-4) and 5, and immunohistochemical analyses of urine leukocytes (CD45RO positive cells as a T cell marker) before treatment. These parameters were also measured 4 and 12 months after continuous treatment. The voiding chart, and interstitial cystitis symptom and problem indexes were evaluated before and after IPD-1151T treatment. RESULTS: IPD-1151T treatment for 1 year resulted in a significantly increased bladder capacity and decreased symptoms, such as urinary urgency, frequency and lower abdominal pain, in patients with nonulcerative interstitial cystitis. These effects also correlated with a reduction in blood eosinophils, CD20 positive cells and IgE, and urine CD45RO positive memory T cells. No major side effects were observed. CONCLUSIONS: Our study suggests that immunological responses are involved in the development of interstitial cystitis symptoms. IPD-1151T could be a new oral agent for treatment of voiding symptoms and bladder pain in patients with interstitial cystitis.     

Is interstitial cystitis an allergic disorder?: A case of interstitial cystitis treated successfully with anti-IgE

Interstitial cystitis (IC) is a chronic disorder diagnosed by symptomatology of pelvic pain and urinary frequency, which are extremely variable and unpredictable fluctuating among patients. IC has recently been found combined with some allergic disorders and histopathologic abnormalities resembling that of allergic disorders, including mast cell activation, histamine release and eosinophil infiltration. Therefore, it could be cautiously postulated that IC is one of the allergic disorders of the urogenital system. A 28-year-old Caucasian female patient, who was diagnosed with asthma and allergic rhinitis, suffered from bladder symptoms of frequency, urgency and pelvic pain for the past 3 years. The symptoms disturbed her every day and were intractable for treatment. Urologists concluded that she had interstitial cystitis. Specific immunotherapy (SIT) was recommended for her allergic symptoms. While taking specific immunotherapy, she had anaphylaxis. She still had the reaction even with the 1000-fold diluted shot of SIT. Omalizumab was used for her allergic symptoms and possible prevention of anaphylactic reaction to SIT. Interestingly, she reported that her urogenital symptoms had subsided since omalizumab had been started. According to the published literature, we postulate that interstitial cystitis might be one of the IgE mediated, mast cell driven allergic disorders of the urogenital system. Therefore, in this case, the patient's bladder symptoms are successfully controlled primarily by anti-IgE therapy and the improvement could be maintained by SIT. We report, for the first time, a case of interstitial cystitis with allergic rhinitis and asthma, successfully treated by anti-IgE therapy and specific immunotherapy.     

Management of interstitial cystitis with ileocecocystoplasty

Two patients rendered urinary cripples from contracted bladders secondary to interstitial cystitis underwent ileocecocystoplasty for bladder expansion. The technique and advantages of this procedure are outlined. Both patients have satisfactory voiding patterns, insignificant residual urine, and normal renal function up to two years. Although this procedure is performed infrequently, it can significantly benefit the patient with a severely contracted bladder.     

A case of middle lobar bulla associated with severe bronchial asthma]

We experienced a case of middle lobar bulla associated with severe bronchial asthma. Bulla occurs favoritely at apical area and S6, and middle lobar bulla which is very rare has been reported to cause higher ventilatory disorder compared with superior lobar bulla, when it becomes giant. The pathogenesis of the present middle lobar bulla remains unknown, but steroid administration to bronchial asthma may possibly have influenced pleura and/or lung parenchyma. We would like to make its further observation, paying attention to its possible recurrence and its occurrence at other sites.     

A case of familial clustering of interstitial cystitis and chronic pelvic pain syndrome

A case of familial clustering of interstitial cystitis (IC) and chronic pelvic pain syndrome (CPPS), a symptom complex similar to IC that occurs in men, is reported. The proband was a 28-year-old woman with a 6-month history of severe frequency, urgency, and genital pain. After cystoscopy with hydrodistention and biopsy, a diagnosis of IC was made. IC was also diagnosed in the patient's mother and in two of her brothers, previously considered to have CPPS (category IIIB CPPS). A third brother was asymptomatic. This case highlights the importance of genetic factors in the onset of symptoms and natural history of IC and CPPS.     

Nephrogenic adenoma associated with interstitial cystitis

A nephrogenic adenoma occurring in a forty-five-year-old male with a past history of urinary tract infection and interstitial cystitis is described. Four years after the diagnosis of interstitial cystitis, nephrogenic adenoma developed. The patient underwent a total cystoprostatectomy and urinary diversion for bilateral vesicoureteral reflux and progressive and incapacitating symptoms that persisted in spite of accepted standards of management for this disease. This case further supports the role of chronic inflammatory processes of the bladder in the subsequent development of nephrogenic adenoma.     

间质性膀胱炎的流行病学

近年有关间质性膀胱炎的患病率结合了验证有效的症状量表的结果评价患者的症状,发现问质性膀胱炎实际患病率远高于以前的结果.     

Diagnosis of interstitial cystitis

We reviewed clinical and histological findings in 55 patients with interstitial cystitis and 21 with voiding dysfunction secondary to other pathological conditions. Of our interstitial cystitis patients 36% would fail to meet the research definition proposed at a recent National Institutes of Health workshop. Detrusor mastocytosis was present in 64% of our interstitial cystitis patients compared to 80% of the noninterstitial cystitis group. There was no statistically significant difference in mean detrusor mast cell counts between interstitial cystitis and noninterstitial cystitis patients. Biopsies of 12 patients who did meet the proposed National Institutes of Health research definition were evaluated by immunohistochemical techniques. Early results are inconclusive. These studies indicate that interstitial cystitis is a complex disease whose diagnosis presently still must be made from a symptom complex rather than from objective histological criteria, including mastocytosis or the presence of any specific immunoreactive cell.     

间质性膀胱炎的研究进展

间质性膀胱炎对于泌尿外科、妇产科医生仍是一大未攻克的难题。目前的诊断仍以排除性诊断为主。腰麻下进行膀胱镜检查仍是临床诊断的重要组成部分之一。还未有一种单一的药物治疗能够应用到所有病患人群。选择最少毒性作用的序贯治疗可能是最好的治疗手段,而联合药物治疗可能也有临床价值。     

Pathophysiology of interstitial cystitis

Interstitial cystitis/bladder pain syndrome is a chronic pain syndrome whose causes remains elusive with no generally accepted treatment. A hallmark of functional pain syndromes such as interstitial cystitis/bladder pain syndrome is pain in the absence of demonstrable pathology of the viscera or associated nerves. Patients with chronic pain experience a greater impairment in quality of life than healthy controls. In addition, interstitial cystitis/bladder pain syndrome symptoms can frequently overlap with other conditions including irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, anxiety disorders, and a number of other syndromes not directly related to the urinary bladder. Because of the complex pathophysiology, a number of animal models have been studied over the years to better understand mechanisms underlying patient symptoms. These models can include: bladder centric, complex mechanisms and psychological and physical stress models. Such animal models can aid in the investigation of aspects of interstitial cystitis/bladder pain syndrome that cannot be pursued in humans as well as to develop and test potential therapies. In addition, the search for urinary factors that may be a cause of interstitial cystitis/bladder pain syndrome has resulted in the discovery of a number of potential targets that could serve as predictive biomarkers which can aid in early diagnosis and treatment of this chronic disorder.     

间质性膀胱炎研究进展

间质性膀胱炎始终是泌尿外科学领域的一个热点,但其定义、命名,甚至于流行病学一直不甚清楚.这篇综述中,我们总结了近年来在间质性膀胱炎研究中取得的一些重要成果,其中包括流行病学、定义、诊断以及治疗等.虽然目前间质性膀胱炎的治疗没有突破性的进展,但供临床医生选择的治疗方案也在逐渐增多,为以后的研究奠定了基础.     

间质性膀胱炎研究进展

间质性膀胱炎始终是泌尿外科学领域的一个热点,但其定义、命名,甚至于流行病学一直不甚清楚.这篇综述中,我们总结了近年来在间质性膀胱炎研究中取得的一些重要成果,其中包括流行病学、定义、诊断以及治疗等.虽然目前间质性膀胱炎的治疗没有突破性的进展,但供临床医生选择的治疗方案也在逐渐增多,为以后的研究奠定了基础.     

间质性膀胱炎研究进展

间质性膀胱炎始终是泌尿外科学领域的一个热点,但其定义、命名,甚至于流行病学一直不甚清楚.这篇综述中,我们总结了近年来在间质性膀胱炎研究中取得的一些重要成果,其中包括流行病学、定义、诊断以及治疗等.虽然目前间质性膀胱炎的治疗没有突破性的进展,但供临床医生选择的治疗方案也在逐渐增多,为以后的研究奠定了基础.     

Successful therapy of interstitial cystitis with pentosanpolysulfate

Sodium pentosanpolysulfate (Elmiron) is a synthetic, sulfated polysaccharide available in an oral form that is excreted into the urine. This drug was used in a double-blind fashion to evaluate its efficacy in the management of symptoms of interstitial cystitis. A dose of 100 mg. 3 times daily was used for a minimum of 4 months and was continued for longer than 18 months in some individuals. A total of 62 patients was evaluated from 2 different medical centers. Subjective improvements were greater in all parameters when the drug was compared to placebo therapy, with significant improvement in pain, urgency, frequency and nocturia. Objective improvement in average voided volumes was greater with the drug than with placebo (p equals 0.009). No significant difference was found between drug and placebo groups in the average number of daily voiding episodes.