A controlled study of dimethyl sulfoxide in interstitial cystitis

To evaluate the effectiveness of dimethyl sulfoxide in the treatment of patients with biopsies suggestive of interstitial cystitis, 33 patients underwent a controlled crossover trial. Patients were allocated randomly to receive 50 per cent dimethyl sulfoxide or placebo (saline). The medication was administered intravesically every 2 weeks for 2 sessions of 4 treatments each. Response was assessed urodynamically and symptomatically. Thirty women and 3 men (mean age 48 years and mean duration of symptoms 5.5 years) were entered into the study. No significant side effects to dimethyl sulfoxide were noted. When assessed subjectively, 53 per cent of dimethyl sulfoxide treated patients were markedly improved compared to 18 per cent of the placebo treated patients. Of the dimethyl sulfoxide group 93 per cent had objective improvement versus 35 per cent of the placebo group. Thus, dimethyl sulfoxide proved to be superior to placebo in the objective and subjective improvement of patients with interstitial cystitis.     

Eosinophilic cystitis induced by bacillus Calmette-Guerin (BCG) intravesical instillation

Eosinophilic cystitis is a rare and uncommon inflammatory bladder disease, in which the pathophysiology is unclear; only a few cases of such disease induced by intravesical instillations have been described. We report a case of eosinophilic cystitis after intravesical bacillus Calmette-Guerin (BCG) instillation for nonmuscle-invasive transitional cell carcinoma of the bladder. To our knowledge, this report is the first case of eosinophilic cystitis induced by intravesical BCG therapy.     

Self-administration of dimethyl sulfoxide (DMSO) for interstitial cystitis

Ten patients with biopsy-proved interstitial cystitis were treated with a program of self-administered dimethyl sulfoxide (DMSO) using the technique of intermittent self-catheterization. Nine of the 10 patients responded favorably to the treatment and are on a maintenance program. The technique was well tolerated and without complications.     

Long-term outcomes of intravesical dimethyl sulfoxide/heparin/hydrocortisone therapy for interstitial cystitis/bladder pain syndrome

Introduction and hypothesis

For decades, intravesical dimethyl sulfoxide (DMSO) cocktail therapy has been used for the treatment of interstitial cystitis/bladder pain syndrome (IC/BPS), but little is known about its long-term efficacy. We aimed to assess the long-term efficacy of intravesical DMSO/heparin/hydrocortisone/bupivacaine therapy in patients with IC/BPS.

Methods

Patients with IC/BPS from our institutions who underwent this therapy with >2 years follow-up were surveyed with O’Leary–Sant interstitial cystitis symptom and problem index questionnaires before and after therapy. Chart reviews and telephone surveys were then conducted to determine their posttherapy course.

Results

Of 68 eligible women, 55 (80.0%) with a median follow-up of 60 months (range 24–142) were surveyed. Their mean age at therapy onset was 44.8 years and their mean body mass index was 26.2 kg/m². There were statistically significant improvements in O’Leary–Sant and pain scores of 23–47% at both 6 weeks and the end of the follow-up period. At the end of the follow-up period, 19 of the 55 women (34.5%) were cured (requiring no further treatment) and 12 (21.8%) were significantly improved (requiring only ongoing oral medication). Univariate and multivariate analyses showed that DMSO treatment failure was more likely in patients with pretreatment day-time urinary frequency more than 15 episodes per day (OR 1.41), nocturia more than two episodes per night (OR 2.47), maximum bladder diary voided volume <200 ml (OR 1.39) and bladder capacity under anaesthesia <500 ml (OR 1.6).

Conclusions

At a median follow-up of 60 months, intravesical DMSO cocktail therapy appeared moderately effective for the treatment of IC/BPS. Treatment failure was more frequent in patients with pretreatment symptoms of reduced bladder capacity.

     

Eosinophilic cystitis

Authors report on two rare cases of eosinophilic cystitis, giving a review of the etiologic assumptions and pathogenetic, pathologic aspects of the disease, based on the available literary data. The course of the disease can be either acute or subacute, and is most often chronic. Relapse and progression can interchange in irregular manner, attention is therefore called to the importance of follow-ups. Resection deep into the intact--also containing muscle fibre--as well as histologic examination are considered essential as the only method of differentiation, giving precise diagnosis in the present two cases, too.     

Eosinophilic cystitis

4 cases of eosinophilic granulomatous cystitis are reported. The clinical presentation of this rare entity is disucssed. It is suggested that the lesion is probably akin to eosinophilic enteritis or eosinophilic granuloma of the gastrointestinal tract and represents a local intense allergic reaction of eosinophilic type. The causative agents are yet to be identified. Management by an allergist is suggested as a first line of treatment as it appears that the bladder lesions are usually too extensive for local resection.     

Eosinophilic cystitis

The fourteenth documentation of eosinophilic cystitis is presented with a review of the features characterizing this disorder.     

Measuring the success of combined intravesical dimethyl sulfoxide and triamcinolone for treatment of bladder pain syndrome/interstitial cystitis

Introduction and hypothesis

The purpose of this study was to investigate change in bladder capacity as a measure of response to combined intravesical dimethyl sulfoxide (DMSO) and triamcinolone instillations for the treatment of newly diagnosed bladder pain syndrome/interstitial cystitis (BPS/IC).

Methods

141 newly diagnosed women were identified retrospectively. 79 were treated with weekly DMSO/triamcinolone instillations. Change in bladder capacity with bladder retrofill, daytime urinary frequency, nocturia episodes per night, and Likert scale symptom scores were reviewed. Wilcoxon signed-rank tests, Wilcoxon rank-sum tests, Spearman’s rank correlations, COX regression analysis, and a Kaplan-Meier survival curve were performed.

Results

Significant changes (median (25^th-percentile to 75^th-percentile) were noted for bladder capacity (75 mL (25 to 130 mL), p?<?0.0001), inter-void interval (0 hrs (0 to 1 hour), p?<?0.0001), nocturia episodes per night (?1 (?2 to 0), p?<?0.0001), and aggregate Likert symptom scores (?2 points (?5 to 0), p?<?0.0001). Percent change in bladder capacity correlated positively with percent change in inter-void interval (p?=?0.03) and negatively with percent changes in nocturia (p?=?0.17) and symptom scores (p?=?0.01). Women without detrusor overactivity (DO) had greater percent changes in capacity than women with DO (62.5 % vs. 16.5 %, p?=?0.02). 61.3 % of patients were retreated with a 36 weeks median time to retreatment and no difference in time to retreatment based upon DO. Greater capacity was protective against retreatment (hazard ratio?=?0.997 [95 % CI 0.994,0.999], p?=?0.02).

Conclusions

Percent change in bladder capacity is a useful objective measure of response to intravesical DMSO/triamcinolone for newly diagnosed BPS/IC. Clinical outcomes do not differ based upon presence of DO.     

Intravesical dimethyl sulfoxide for primary amyloidosis of the bladder

Primary bladder amyloidosis is a rare disease. Treatment recommendations are necessarily anecdotal. We report a case of a 52-year-old woman treated successfully with intravesical dimethyl sulfoxide instillation.     

Eosinophilic cystitis. A rare inflammatory pathology mimicking bladder neoplasms

PURPOSE: We present a large series of eosinophilic cystitis including 8 cases; 3 of them had tumor-like lesions. MATERIALS AND METHODS: The archives of pathology clinic of Inonu University Medical Faculty were reviewed from 1988 to 2002. The characteristics of patients and their diseases were recorded. Data obtained from 180 cases (172 from the literature and 8 from the present series) was assessed. RESULTS: Seven cases had symptoms such as dysuria, frequency, hematuria, suprapubic pain, and difficulty in voiding. One asymptomatic case with history of bladder carcinoma was diagnosed during routine cystoscopy. The findings were microhematuria in 6 cases, macrohematuria in 2, pyuria in 3, urinary infection in 1, eosinophilia in 1, hyperazotemia in 1, and bladder masses in 3. Cystoscopies detected edematous and erythematous areas in 5 cases and lesions mimicking bladder carcinoma in 3. One case did not take further treatment after cystoscopy and biopsy and completely recovered. Four cases underwent medical therapy with nonsteroidal anti-inflammatory drugs and antihistaminics. They became asymptomatic and control cystoscopies showed no abnormal finding. Two of three patients with mass lesions recovered after steroid therapy following transurethral resection. The lesion in the third recurred and he improved after a second course of steroid therapy. CONCLUSIONS: Eosinophilic cystitis is a rare pathology. Sometimes, it may simulate bladder malignancies. Biopsy is mandatory at diagnosis. Usually, it has a benign course and may be treated with fulguration, analgesics, antihistaminics and steroids, although recurrence is possible.     

Primary localized amyloidosis of the bladder: experience with dimethyl sulfoxide therapy

PURPOSE: We present our long-term experience with intravesical dimethyl sulfoxide (DMSO) for primary localized amyloidosis of the bladder. MATERIALS AND METHODS: The study included 4 males and 2 females 28 to 68 years old (mean age 54) at diagnosis of biopsy proven primary localized amyloidosis involving the bladder diffusely or extensively in 1 locale. All patients had normal upper urinary tracts. They continued to be symptomatic (hematuria in 3, irritative voiding symptoms in 1, and hematuria and irritative voiding symptoms in 2) despite conventional transurethral destructive therapy. Every 2 weeks they received 30-minute instillations of 50 ml. 50% DMSO intravesically for 3 months (patient 1), 6 months (1) and 1 year (4). RESULTS: Therapy failed at 3 and 6 months in 2 patients of whom 1 with a contracted bladder underwent cystectomy and another was stabilized for 1 year with laser therapy. In the remaining 4 patients who were followed for 6 years disease stabilized for 2 to 6 years (mean 3.5) but 3 later required additional therapy including repeat DMSO in 1 and laser therapy in 2. CONCLUSIONS: Diffuse or locally extensive bladder involvement by primary localized amyloidosis usually fails to respond to conventional transurethral destructive surgical procedures. Collectively, our experience and the literature suggest that intravesical DMSO can be a bladder saving measure and help resolve ureterovesical obstruction in some patients. High recurrence rate mandates lifelong cystoscopic surveillance.     

Experience with dimethyl sulfoxide treatment for primary localized amyloidosis of the bladder

We report a case of primary localized amyloidosis of the bladder treated successfully with transurethral resection and intravesical dimethyl sulfoxide instillation. Dimethyl sulfoxide bladder instillation is useful for the treatment of primary localized amyloidosis of the bladder.     

Eosinophilic cystitis.

Allergy is an unlikely cause of the eosinophilic cystitis in the case presented because of the young age of the patient and the insignificant levels of IgE (immunoglobulin E) found in her serum.     

Prospective study of intravesical dimethyl sulfoxide in treatment of suspected early interstitial cystitis

The efficacy of intravesical instillations of dimethyl sulfoxide (DMSO) in the treatment of suspected early interstitial cystitis was investigated in a prospective study. Among 20 patients treated, complete symptomatic remissions were achieved in 3, partial symptomatic remissions were achieved in 16, and 1 had no symptomatic improvement. However, functional bladder capacities following treatment were increased by more than 25 per cent in only 4 cases. Among 16 patients who experienced symptomatic remissions and who have been followed for > four months, 14 had sustained remissions (mean follow-up eleven months) and 2 had unsustained remissions. Clinically apparent toxicity was minimal but transient elevation of the serum lactic acid dehydrogenase was occasionally observed during treatment. DMSO appears to be useful in the management of carefully selected patients with suspected early interstitial cystitis.     

Eosinophilic cystitis simulating invasive bladder cancer: a real diagnostic challenge

Objectives To report our experience with eosinophilic cystitis (EC) presented as invasive bladder cancer. Materials and methods We recently treated three patients with bladder masses mimicking neoplasms and biopsy proved the diagnosis of EC. Data from our three patients were presented. Results There were two females and one male with ages of 14, 43 and 38 years. All the three patients had irritative bladder symptoms, suprapubic pain and hematuria. Bladder mass was detected by pelvic examination in the three patients and confirmed by radiologic tests and cystoscopy. In one patient, the mass caused bilateral hydroureteronephrosis while the upper tract was normal in the other two. Elevated serum leukocytes was evident in the three cases while peripheral eosinophilia was observed in one. Biopsy showed EC in all the three patients who were treated by transurethral resection of the lesions followed by a combination of corticosteroids, antibiotics and antihistaminics. All patients experienced marked improvement during a follow-up duration up to 30 months. Conclusion EC is a rare disease. In addition to symptoms of frequency, dysuria, hematuria and suprapubic pain, the disease may present with a bladder mass mimicking invasive bladder cancer. Resection of the lesion is mandatory with systemic treatment of corticosteroids, antihistaminics and antibiotics. Early detection and prompt treatment usually result in a good prognosis.     

Eosinophilic cystitis in a case presenting with an initial diagnosis of invasive bladder tumor

Eosinophilic cystitis is a rare condition of the bladder that presents with hematuria, dysuria and suprapubic tenderness. A case of eosinophilic cystitis presenting as an invasive bladder tumor is reported.     

Eosinophilic cystitis in children

Eosinophilic cystitis is an uncommon inflammatory disorder of the urinary bladder which causes irritative voiding symptoms and may mimic rhabdomyosarcoma radiographically. In children, eosinophilic cystitis has been previously reported to be self-limiting and requires no specific therapy. Reported herein is a case of a nine-year-old girl in whom eosinophilic cystitis recurred following antireflux surgery, raising the question of an association of eosinophilic cystitis with local trauma such as bladder surgery. Consideration should be given to pretreatment with steroids and antihistamines prior to surgery in these patients.