A型肉毒毒素膀胱三角区黏膜下注射治疗氯胺酮相关性膀胱炎的临床观察

目的探讨A型肉毒毒素(BTX-A)联合碱化利多卡因膀胱灌注+水压扩张治疗氯胺酮相关性膀胱炎的疗效。方法将33例氯胺酮相关性膀胱炎患者按治疗方式分为2组:A组15例,采用碱化利多卡因膀胱灌注+水压扩张;B组18例,在同A组治疗的基础上,加用膀胱三角区黏膜下注射BTX-A治疗。评估患者治疗前及治疗后1周、1个月、3个月的临床症状改善情况(每日排尿次数、最大排尿量、OLeary-Sant间质性膀胱炎症状评分ICSI及ICPI评分作为疗效评判标准),并记录不良反应的发生情况。结果 B组在治疗后1周、1个月、3个月症状较A组明显改善;各时间点每日排尿次数、最大排尿量、ICSI评分及CIPI评分与A组相比均有显著差异(P0.05)。两组均未出现严重不良反应。结论 BTX-A联合碱化利多卡因水压扩张治疗氯胺酮相关性膀胱炎,是一种安全有效的治疗方法,且无严重并发症。     

舍尼亭联合α受体阻滞剂治疗BPH伴逼尿肌过度活动的临床研究

目的:评价舍尼亭联合α受体阻滞剂治疗良性前列腺增生伴逼尿肌过度活动的有效性及安全性。方法:将113例良性前列腺增生伴逼尿肌过度活动患者随机分为A、B两组,A组联合应用舍尼亭(4 mg,1次/d)及可多华(4 mg,1次/d);B组单独使用可多华,治疗时间为12周,记录并比较治疗前后两组患者平均24 h排尿次数、IPSS及QOL评分、最大尿流率、残余尿量及尿潴留次数。结果:治疗后A组平均24 h排尿次数、IPSS及QOL评分改善较B组明显[(3.9±1.25vs2.6±1.37)、(4.4±1.27vs2.2±0.91)、(1.8±1.04)vs(0.5±0.26),P均<0.05];最大尿流率、残余尿量变化两组没有明显差异,两组病例均未发生尿潴留。结论:舍尼亭联合α受体阻滞剂能有效缓解良性前列腺增生伴逼尿肌过度活动患者的排尿困难及尿频、尿急等症状,联合用药后未发现舍尼亭对患者最大尿流率、残余尿量的影响,不增加急性尿潴留的发生率。     

肉毒素联合膀胱灌注治疗间质性膀胱炎

目的:评价肉毒素注射联合肝素、利多卡因、碳酸氢钠膀胱灌注治疗间质性膀胱炎的疗效。方法:将20例间质性膀胱炎患者随机分为两组,联合组在麻醉下行膀胱内200 U肉毒素多点注射,3 d后行2%利多卡因8 mL、肝素37 500万U、5%碳酸氢钠5 mL膀胱灌注,每周1次,治疗周期1个月;透明质酸钠组膀胱灌注每周1次,治疗周期1个月,并对疗效进行随访。结果:随访1年,透明质酸钠组症状评分、问题评分、日排尿次数、最大膀胱容量指标较治疗前未发现明显改善(P0.05);联合组以上指标较治疗前均有明显改善(P0.05)。结论:肉毒素联合肝素、利多卡因、碳酸氢钠膀胱灌注治疗间质性膀胱炎,疗效明显优于透明质酸钠,该治疗方案值得进一步临床推广应用。     

阿米替林联合透明质酸钠、肝素治疗间质性膀胱炎的临床疗效评价

目的探讨口服阿米替林联合膀胱灌注透明质酸钠、肝素治疗间质性膀胱炎/膀胱疼痛综合征（interstitial cystitis/painfulbladder syndrome,IC/PBS）的临床疗效和安全性。方法 24例IC/PBS患者行口服阿米替林联合膀胱灌注透明质酸钠、肝素治疗。麻醉下膀胱镜检查及水扩张后,诊断明确所有患者即开始口服阿米替林25mg/d,最大剂量75mg/d;同采用透明质酸40mg、肝素25 000U混合液膀胱灌注、每周1次,4次后改每月1次。观察治疗前及治疗后3、6个月的排尿次数、排尿量和Oleary saint问卷表评分（OLeary-Sant patient symptom/problem index scores,ICSI/ICPI）;盆腔疼痛及尿频评分（pelvic painand urgency frequency questionnaire,PUF）;第6月复查膀胱镜。结果 22例患者完成本研究,随访3、6月时,每日排尿次数明显减少,尤其是夜尿次数,平均每次尿量明显增加,ICSI、ICPI、PUF评分明显降低,差异有统计学意义（P〈0.001）;治疗6月与治疗3月相比差异除夜尿次数及PUF评分外,其他各项指标均无统计学意义（P〉0.05）。6月复查膀胱镜检查,19例黏膜下出血点消失或减轻,3例膀胱三角区炎性改变。结论阿米替林联合透明质酸钠、肝素治疗IC/PBS安全有效。     

膀胱水扩张联合灌注树胶脂毒素治疗间质性膀胱炎的疗效分析

目的 评价使用腰麻下膀胱水扩张联合灌注树胶脂毒素(RTX)治疗间质性膀胱炎(IC)的疗效.方法 回顾性分析16例间质性膀胱炎患者,均使用腰麻下行水扩张加RTX膀胱灌注.评价治疗前、后1个月以及6个月的排尿次数,排尿量以及临床症状比较.结果 所有患者治疗前与治疗后1个月以及6个月的排尿频率、最大膀胱容量以及临床症状评分相...     

膀胱水扩张联合灌注树胶脂毒素治疗间质性膀胱炎的疗效分析

目的 评价使用腰麻下膀胱水扩张联合灌注树胶脂毒素(RTX)治疗间质性膀胱炎(IC)的疗效.方法 回顾性分析16例间质性膀胱炎患者,均使用腰麻下行水扩张加RTX膀胱灌注.评价治疗前、后1个月以及6个月的排尿次数,排尿量以及临床症状比较.结果 所有患者治疗前与治疗后1个月以及6个月的排尿频率、最大膀胱容量以及临床症状评分相比,均有明显改善差异有统计学意义(P＜0.05).16例患者中14位患者有不同程度的症状改善.2例患者的临床症状消失或明显改善.结论 RTX膀胱灌注以及膀胱水扩张对于间质性膀胱炎是短期内安全有效改善症状的治疗方法.     

肉毒素A联合透明质酸钠治疗间质性膀胱炎的疗效观察

目的 探讨肉毒素A膀胱内注射联合透明质酸钠膀胱灌注治疗间质性膀胱炎(IC/PBS)的有效性和安全性.方法 53例IC/PBS患者,其中行肉毒素A膀胱内注射联合透明质酸钠膀胱灌注28例(A组),单纯行透明质酸钠膀胱灌注25例(B组).观察并记录患者治疗前及治疗2周、1、3、6个月的临床症状(每日排尿次数、最大排尿容量、VAS疼痛评分)和O'Leary-Sant IC问卷表评分情况,治疗完成后进行疗效评估,并记录不良反应发生情况.结果 A组患者治疗各时间点的每日排尿次数、最大排尿容量、VAS疼痛评分、O' Leary-Sant评分与治疗前相比差异均有统计学意义(P＜0.05);B组患者治疗2周和治疗前比较差异无统计学意义(P＞0.05),其余治疗的各时间点和治疗前比较均有统计学意义(P＜0.05).治疗完成后,两组患者下腹酸胀/疼痛改善率分别为82.1％ (23/28)和68.0％(17/25),夜尿次数多改善率分别为78,6％(22/28)和64.0％ (16/25),尿频尿急改善分别为60.1％ (17/28)和28.0％(7/25),组间疗效评估结果差异均有统计学意义(P ＜0.05,其中尿频尿急改善率差异P＜0.01).A、B两组各有5例在膀胱灌注后出现尿路感染,口服抗生素后缓解.所有患者均完成治疗及随访.结论 肉毒素A膀胱内注射联合透明质酸钠膀胱灌注治疗IC/PBS能够迅速有效的缓解患者临床症状,较单纯透明质酸灌注能更好地改善IC/PBS所造成的下腹酸胀/疼痛、夜尿次数多和尿频尿急,提高患者生活质量,为治疗IC/PBS提供了一种新的有效方法.     

膀胱镜随机活检及麻醉下水扩张对膀胱疼痛综合征/间质性膀胱炎诊治的价值

目的 探讨膀胱镜随机活检及麻醉下水扩张对诊断和治疗膀胱疼痛综合征/间质性膀胱炎(bladder pain syndrome/interstitial cystitis,BPS/IC)的临床意义. 方法 回顾性分析2005年至2010年我院因膀胱疼痛等下尿路症状入院的119例患者的临床资料.男32例,年龄47～ 64岁,平均56岁;女87例,年龄23 ～ 67岁,平均49岁.初步诊断均为BPS/IC.入院后行排尿日记、疼痛及症状评分、QOL、尿细菌学培养、尿找肿瘤细胞、尿找抗酸杆菌等检查.全麻后行膀胱镜检膀胱黏膜随机活检,然后进行膀胱镜麻醉下水扩张,对水扩张前后IC患者每日排尿次数、最大排尿量、疼痛评分、O 'Leary-Sant问卷症状评分、QOL等指标进行比较. 结果 119例经膀胱镜随机活检及麻醉下水扩张,确诊为IC患者102例,治疗前每日排尿次数为(42.1±5.6)次,最大排尿量为(141.0 ±8.3)ml,疼痛评分为(7.6±3.0)分,O'Leary-Sant问卷症状评分为(27.7±4.2)分,QOL为(7.6±2.4)分.治疗后每日排尿次数为(23.3±3.4)次,最大排尿量为(352.0±1.7)ml,疼痛评分为(3.3±4.3)分,O 'Leary-Sant问卷症状评分为(12.5±7.3)分,QOL为(3.2±5.1)分,与治疗前比较差异均有统计学意义(P＜0.05).非IC患者17例,确诊为膀胱尿路上皮癌8例,其中原位癌4例、低级别非浸润性膀胱癌l例、高级别浸润性膀胱癌3例,其中4例无血尿症状,膀胱疼痛症状出现至确诊的平均时间为10.8个月.确诊为结核性膀胱炎3例,嗜酸性膀胱炎1例,化学性膀胱炎3例,放射性膀胱炎2例.结论 BPS仍需采用排除性诊断才能确诊为IC.膀胱镜随机活检及麻醉下水扩张对BPS的诊疗有重要意义.     

含三角区的逼尿肌内BTX-A重复注射术联合间歇导尿治疗成年男性脊髓损伤并NDO和尿失禁的疗效及安全性

目的评估含三角区的逼尿肌内A型肉毒毒素(BTX-A)重复注射术联合间歇导尿治疗成年男性脊髓损伤并神经源性逼尿肌过度活动(NDO)和尿失禁的疗效和安全性。方法回顾性分析2012年1—8月广东省工伤康复医院采用含三角区的逼尿肌内BTX-A重复注射术治疗43例成年男性脊髓损伤伴NDO和尿失禁患者的资料。年龄(29.1±10.7)岁, 术前尿失禁生活质量问卷评分(I-QOL)(39.0±4.8)分, 每日尿失禁(11.9±2.6)次, 每次排尿量(170.7±20.1)ml, 首次出现NDO时膀胱逼尿肌最大压力(81.4±19.6)cmH2O(1cmH2O=0.098kPa), 首次出现NDO时膀胱容量(169.1±40.0)ml。经尿道将300 U BTX-A分30个点注射于包括膀胱三角区的逼尿肌内。留置尿管1～3 d后改为间歇导尿。间隔6～9个月重复注射, 共注射4次。记录每次注射12周后I-QOL、排尿日记及影像尿动力学检查结果, 并观察不良事件。结果患者4次BTX-A注射间隔时间分别为(220.6±27.4)、(222.8±24.2)、(224.4±39.0)d(P=0.13)。与首次...     

经尿道膀胱电灼术治疗难治性非溃疡型间质性膀胱炎/膀胱疼痛综合征

目的探讨经尿道膀胱电灼术治疗难治性非溃疡型间质性膀胱炎/膀胱疼痛综合征(IC/PBS)的有效性和安全性。方法回顾性分析56例难治性非溃疡型女性IC/PBS患者的临床资料。随机分为试验组(n=35)和对照组(n=21)。试验组先行麻醉下水扩张,再对膀胱黏膜丝球样出血点密集处行经尿道膀胱电灼术。对照组单纯行麻醉下水扩张1次。比较2组患者治疗前1周、治疗后1周及1、3、6月的间质性膀胱炎指数评分(ICSI)及问题指数评分(ICPI)、盆腔疼痛和尿急/尿频患者症状评分(PUF)、24h排尿次数及平均每次排尿量,并观察患者治疗期间的不良事件。结果 56例患者治疗后均随访6月以上,试验组患者治疗后1周及1、3、6月的ICSI评分、ICPI评分、PUF评分、24h排尿次数均显著低于治疗前,平均每次排尿量明显增加,治疗前后比较差异均有统计学意义(P0.01)。试验组患者治疗后1周及1、3、6月的各项评分及24h排尿次数均显著低于对照组相应时间点,平均每次排尿量明显增加,2组比较差异均有统计学意义(P0.01)。试验组患者治疗后1周及治疗后1、3、6月的症状缓解率分别为88.6%(31/35)、82.9%(29/35)、80%(28/35)和71.4%(25/35)。所有患者在治疗期间均未发生明显的不良事件。结论经尿道膀胱电灼术能有效缓解难治性非溃疡型IC/PBS患者的临床症状,其远期疗效有待于进一步观察。     

Botulinum toxin type A may improve bladder function in a rat chemical cystitis model

The purpose of this study was to investigate the effect of botulinum toxin type A on bladder function and histology in a rat chemical cystitis model. The study included 41 female Sprague-Dawley rats with chemical cystitis induced by intravesical instillation of hydrochloric acid. The acid instillation was repeated monthly to maintain chronic inflammation. The treatment group (n=21) received 2-3 units of botulinum toxin type A injected into the bladder detrusor at the 3, 6, 9 and 12 o'clock positions, and the control group (n=20) underwent saline injection into the bladder detrusor at the same positions. Urodynamic studies were performed in all rats before the treatment and at death. The rats were killed at 1 week, 2 weeks, 1 month and 2 months after treatment. The bladders were removed and examined histologically for mast cells and inflammatory changes. The cystometric findings showed that, at the beginning and end of the experiment, the increases in the maximum bladder capacity and compliance were significantly higher in the treatment group than in the control group (P=0.000 and P=0.025, respectively). The histological studies revealed similar mast cell counts and leukocyte infiltration for the treatment and control groups. In conclusion, in this rat chemical cystitis model, botulinum toxin type A injected into the bladder detrusor led to a functional improvement. Thus, botulinum toxin type A injection may be an alternative, minimally invasive choice to other surgical treatment options in the treatment of a chronic inflammatory condition to improve deteriorated bladder function.     

Botulinum toxin type A for the treatment of lower urinary tract disorders

Many papers report the clinical success of botulinum toxin A as a method of management of various bladder dysfunctions. The rationale was that botulinum toxin A was able to block the presynaptic release of acetylcholine from the parasympathetic efferent nerve. The efficacy might result not only from an inhibitory effect on detrusor muscle, but also some effects might be mediated by altering the afferent nerve input. This systematic literature review discusses the efficacy and safety of botulinum toxin A therapy for idiopathic detrusor overactivity, neurogenic detrusor overactivity, interstitial cystitis/painful bladder syndrome and benign prostatic hyperplasia. The information was gathered from a PubMed literature research for abstracts from recent urological meetings. Injection of botulinum toxin A appears to have a positive therapeutic effect in multiple urological conditions, such as refractory idiopathic detrusor overactivity, neurogenic detrusor overactivity, interstitial cystitis/painful bladder syndrome and benign prostatic hyperplasia. Because the United States Food and Drug Administration has approved botulinum toxin A (Botox) for injection for the treatment of urinary incontinence as a result of neurogenic detrusor overactivity (e.g. spinal cord injury, multiple sclerosis) in adults who have an inadequate response to or are intolerant of an ant cholinergic medication, the use of botulinum toxin A will spread and be a more familiar therapy in the urological arena. However, further robust evidence should be awaited. We will discuss the current use of this agent within the urological field.     

Preliminary results of suburothelial injection of botulinum a toxin in the treatment of chronic interstitial cystitis

PURPOSE: Treatment of interstitial cystitis is usually not successful in eradicating bladder pain and increased bladder capacity. This study was designed to evaluate the clinical effectiveness of suburothelial injection of botulinum A toxin in patients with chronic interstitial cystitis. METHODS: Eight women and 2 men with chronic interstitial cystitis who had failed conventional treatments were enrolled in this study. In 5 patients, 100 units of botulinum A toxin was injected suburothelially into 20 sites, and an additional 100 units was injected into the trigone in the other 5 patients. Therapeutic outcome including functional bladder capacity, number of daily urinations, bladder pain, and urodynamic changes were compared between baseline and 3 months after treatment. RESULTS: In 2 patients bladder pain and urinary frequency were improved 3 months after treatment. Mild difficulty in urination was reported by 7 patients. Functional bladder capacity recorded in a voiding diary was significantly increased (155+/-26.3 vs. 77+/-27.1 ml, p<0.001), and the frequency of daily urinations (18+/-7.7 vs. 24.2+/-10.3, p=0.025) and the pain score (2.4+/-1.6 vs. 3.2+/-1.1, p=0.003) were mildly but significantly reduced after treatment. Only the cystometric capacity improved significantly (287+/-115 vs. 210+/-63.8 ml, p=0.05) in urodynamic results. Trigonal injection had no therapeutic effect on symptom or urodynamic improvement. No adverse effect was reported. CONCLUSIONS: The clinical result of suburothelial botulinum A toxin injection was disappointing. None of the patients was symptom free and only a limited improvement in bladder capacity and pain score was achieved in 2 patients.     

Botulinum toxin type a injections into the trigone to treat idiopathic overactive bladder do not induce vesicoureteral reflux

PURPOSE: We assessed the generation of vesicoureteral reflux before and after injection of botulinum toxin A into the trigone of patients with nonneurogenic overactive bladder, and evaluated its short-term efficacy. MATERIALS AND METHODS: Adults with nonneurogenic overactive bladder resistant to behavioral treatments, pelvic floor exercises, medication and neuromodulation were included in the study. The initial evaluation (history, physical examination, 3-day urinary diary, V8 score, flowmetry and post-void residual) was repeated 6 weeks after botulinum toxin A injection. Videourodynamic study was performed 1 hour before injection and 6 weeks later. Botulinum toxin A (200 units) was injected into the detrusor in 10 sites over the bladder base including the trigone. The primary outcome was the presence or absence of vesicoureteral reflux before and 6 weeks after botulinum toxin A injection. The secondary outcomes were clinical and urodynamic parameter changes. Values were compared using the Wilcoxon test. RESULTS: A total of 12 women were enrolled in the study (median age 76 years). The duration of symptoms was 7.5 years. One patient was excluded from analysis because of a urinary tract infection. There were 10 women with no vesicoureteral reflux at baseline and 1 had bilateral vesicoureteral reflux (grade 2 right, grade 1 left). At 6 weeks there was no induced vesicoureteral reflux and the patient with vesicoureteral reflux at baseline showed no change in vesicoureteral reflux grade. No local or systemic side effects related to botulinum toxin A were reported. In terms of efficacy, at direct questioning 6 weeks after treatment 4 of 11 patients reported an improvement that made them ask for another injection. CONCLUSIONS: Botulinum toxin A injection into the trigone does not induce de novo vesicoureteral reflux in patients with nonneurogenic overactive bladder. The therapeutic value of this approach remains to be confirmed and compared to other injection designs.     

经膀胱镜局部注射肉毒素A治疗逼尿肌反射亢进所致顽固性急迫性尿失禁

目的：探讨经膀胱镜局部注射肉毒素A治疗逼尿肌反射亢进所致顽固性急迫性尿失禁的疗效。方法：对9例确诊为逼尿肌反射亢进且保守治疗无效的急迫性尿失禁患者行膀胱镜引导下逼尿肌内注射肉毒素A,每次剂量300U。术前注意排除伴有膀胱颈梗阻者。比较手术前后患者的临床症状、控尿能力、剩余尿量、初尿意膀胱容量及膀胱最大容量有无差异,有无肉毒素所致的不良反应以及多次注射者有无抗药性产生。结果：9例患者手术过程顺利,术后临床症状、控尿能力、初尿意膀胱容量及膀胱最大容量均较术前有明显改善。剩余尿量无明显变化,无不良反应发生,无肉毒素A的抗药性产生。结论：膀胱镜引导下逼尿肌内注射肉毒素A是一种微创、简便、有效而安全的治疗顽固件逼尿肌反射亢讲的方法。     

Pittsburgh experience with botulinum toxin A injection

We report one institution's six-year experience using botulinum toxin A (BONT-A) in the bladder and urethra in 110 patients for a variety of lower urinary tract dysfunction. 110 patients (age 19-82) were injected with BONT-A into the bladder (n=42) or urethra (n=68), 35 M, 75 F. Voiding dysfunction included: neurogenic detrusor overactivity and/or detrusor sphincter dyssynergia, overactive bladder (OAB), benign prostatic hyperplasia (BPH), bladder neck obstruction (BNO) and interstitial cystitis (IC). Currently, 27 patients have undergone further injections (up to 6) at intervals > 6 months. All the patients with bladder BONT-A injection had preoperative evidence of involuntary detrusor contractions during urodynamic testing. Analysis of the 110 patients indicates that 67.3% reported a decrease or absence of incontinence. Diaries indicate a decrease in both day and night voiding symptoms. Efficacy occurred within 7 days and lasted for at least 6 months. Condition specific QOL symptom scores also demonstrated improvement. There have been no long-term complications. Two MS women with mild baseline stress urinary incontinence reported increased leakage with stress after BONT-A external sphincter injection. One MS woman who had a bladder injection had an increased residual urine from 78 to 155 ml. She did not have to perform intermittent catheterization. BONT-A injection is a safe and promising treatment modality for a variety of lower urinary tract dysfunctions for both skeletal and smooth muscle dysfunction. In our series, BONT-A is equally effective in women as it is in men. Bladder injections with BONT-A are effective for not only neurogenic detrusor overactivity but also overactive bladder. BONT-A can even be considered for IC.     

Botulinum toxin treatment for bladder dysfunction

Botulinum toxin A is available under three different protein complexes that are not interchangeable until appropriate comparative studies are undertaken. The best studied for the treatment of urinary incontinence as a result of neurogenic detrusor overactivity and overactive bladder/idiopathic detrusor overactivity is onabotulinum toxin A. This brand is only approved for the treatment of urinary incontinence as a result of neurogenic detrusor overactivity at a dose of 200 U and idiopathic detrusor overactivity at a dose of 100 U. In patients with detrusor overactivity as a result of spinal cord injury or multiple sclerosis, 200 U of onabotulinum toxin A should be injected in 30 different sites above the trigone. It was shown to be highly effective in curing or decreasing urinary symptoms of incontinence, increasing quality of life, increasing bladder capacity and decreasing maximal detrusor pressure. This effect was independent of the concomitant use of oral anticholinergic drugs. Adverse events were mild, mainly urinary tract infections and high postvoid residual requiring clean intermittent catheterization. In patients with overactive bladder/idiopathic detrusor overactivity, 100 U of onabotulinum toxin A should be injected in 20 sites above the trigone. It markedly decreases urinary incontinence and improves quality of life. Frequency and urgency episodes are also decreased. Adverse events are mild, mainly urinary tract infections and urinary retention. The latter occurred in just 5% of the patients. Candidates for onabotulinum toxin A treatment should be warned that the effect of the toxin is transient and that repeated injections will be required to maintain the effect in the long term. There is no evidence that repeated injections will have a decreased efficacy.     

Botulinum toxin in the management of lower urinary tract dysfunction: contemporary update

PURPOSE OF REVIEW: To review the most recent experience concerning the application of botulinum toxin in the human lower urinary tract. RECENT FINDINGS: Botulinum toxin was initially applied in the bladder of patients with spinal neurogenic detrusor overactivity and urinary incontinence, or in the urethra in cases of detrusor external sphincter dyssynergia. A large multicentric European study fully confirmed the initial expectancy in the former condition. In addition, the application of botulinum toxin was extended to the treatment of other urological disorders including non-neurogenic detrusor overactivity, non-relaxing urethral sphincter and detrusor underactivity. Interesting reports on the injection of botulinum toxin into the prostate of patients with benign prostatic hyperplasia are also reviewed. SUMMARY: Bladder injection of botulinum toxin is not yet an approved treatment for lower urinary tract dysfunction. Nevertheless, available data suggest that in the near future the toxin will become a standard therapeutic option in incontinent patients with neurogenic and non-neurogenic forms of overactive bladder, who do not respond to or do not tolerate anticholinergic medication. In addition, it might be expected that urethral botulinum toxin injections improve bladder emptying in patients with dysfunctional voiding problems besides detrusor external sphincter dyssynergia.     

Painful bladder disease: clinical and pathoanatomical differences in 115 patients

The diagnostic criteria for interstitial cystitis considered as a subgroup of painful bladder disease (that is sensory bladder disease and chronic abacterial cystitis) are not well established. Some urologists rely on symptoms, while others rely on cystoscopic appearance or pathological findings. Among 115 patients with painful bladder disease we compared symptoms, and cystoscopic and urodynamic findings in those with and without detrusor mastocytosis (28 or more mast cells per mm.2) and attempted to elucidate possible differences between the groups. We chose the pathological anatomical criterion of detrusor mastocytosis to be diagnostic for interstitial cystitis. A total of 43 patients had detrusor mastocytosis and other pathological anatomical signs of interstitial cystitis, and 72 had no mastocytosis but the pathological diagnoses of chronic unspecific cystitis, fibrosis of the bladder, detrusor myopathy, intestinal metaplasia and normal findings. When the 2 groups of patients were compared we found no differences in regard to symptoms (pain, dysuria, frequency, nocturia and urgency), frequency of allergy and hysterectomy, duration of symptoms, petechial bleeding during cystoscopy with bladder distension and cystometric findings. The patients with mastocytosis differed from those without mastocytosis in that they were older, and had a higher frequency of hematuria, a higher frequency of a red, scarred and richly vascularized bladder at cystoscopy before distension, and a smaller cystoscopic bladder capacity. We conclude that by dividing patients with painful bladder into 2 groups according to the mast cell counts in the detrusor, certain differences in the clinical findings in the groups can be ruled out. However, in individual patients one cannot note with certainty to which pathological anatomical group the patient belongs, since great overlapping between the groups exists. Whether only patients with detrusor mastocytosis have interstitial cystitis depends on definitions and still remains an open question.