肝素膀胱灌注治疗间质性膀胱炎

目的　观察肝素膀胱灌注治疗间质性膀胱炎的疗效。　方法　 17例间质性膀胱炎患者 ,均为女性。平均年龄 35岁。平均病程 2 7个月。临床表现主要为尿频及膀胱区疼痛。膀胱镜检见黏膜下点状出血 15例 ,Hunner溃疡 2例。按O’Leary Sant间质性膀胱炎症状评分 (ICSI) 8～ 18分 ,平均 (13.4± 3.5 )分 ;问题评分 (ICPI) 3～ 12分 ,平均 (8.2± 3.4 )分。所有患者均使用肝素钠 10 5U膀胱灌注 ,每周 3次 ,疗程 4周。观察治疗后患者症状改善情况。　结果　 17例患者随访 3～ 12个月 ,平均 6个月 ,症状缓解 14例 ,其中症状显著缓解或消失 9例 ,评分下降 7分 ;症状部分缓解 5例 ,评分下降 >3分 ;无效 3例。 2例于治疗 7个月及 9个月症状复发。有效率 82 %。治疗后 1、2个月ICSI分别降至 (6 .1± 3.4 )、(6 .3± 3.5 )分 ,ICPI分别降至 (3.5± 2 .9)、(3.6± 2 .7)分 ,治疗前后比较差异有显著性意义 (P <0 .0 1)。治疗期间发生一过性尿道灼痛者 2例 ,轻微肉眼血尿 1例。　结论　肝素膀胱灌注治疗可有效缓解间质性膀胱炎患者症状 ,提高生活质量。     

膀胱水扩张加肝素灌注治疗女性间质性膀胱炎10例报告

目的观察膀胱水扩张加肝素灌注治疗间质性膀胱炎（IC）的疗效。方法该组10例IC患者均为女性。平均年龄36岁。平均病程30个月。所有患者在麻醉下行膀胱镜检加水扩张,次日均使用肝素钠10^5u加入无菌生理盐水20mL膀胱灌注,完成治疗后以O’Leary-Sant间质性膀胱炎症状评分（ICSI）、每日排尿次数及最大膀胱容量作为疗效评判标准,观察治疗前后患者各项指标情况。结果10例患者按照疗程治疗后随访4-12个月,平均7.5个月,症状缓解4例,症状显著缓解或消失6例;O’Leary-Sant ICSI治疗前为（12.5±4.9）分,平均治疗7个月后降为（6.5±2.3）分（P〈0.01）;治疗前患者平均排尿次数为（14.9±2.6）次／d,完成治疗后患者排尿次数减少至（7.8±2.8）次／d（P〈0.01）;膀胱最大容量治疗前为（73±10）mL,治疗后为（260±56）mL（P〈0.01）。治疗期间发生轻微肉眼血尿2例。结论膀胱水扩张联合肝素膀胱灌注治疗可有效缓解间质性膀胱炎患者症状,提高生活质量,是一种有效的治疗方法。     

膀胱水扩张加膀胱灌注治疗间质性膀胱炎疗效观察

目的膀胱水扩张加膀胱灌注治疗间质性膀胱炎(interstitial cystitis,IC)的临床疗效观察。方法对6例间质性膀胱炎患者行膀胱水扩张及膀胱灌注,分析治疗前、治疗12周后、治疗6个月后间质性膀胱炎症状指数(interstitial cystitissym ptomatic in-dex,ICSI)和问题指数(interstitial cystitis problem index,ICPI)。结果 6例患者均获得满意随访,疗效显著2例、有效3例、无效1例,总有效率为83.3%(5/6)。治疗12周后及治疗6个月后ICSI和ICPI评分均较治疗前明显降低,差异具有统计学意义(P<0.05)。结论膀胱水扩张联合大剂量肝素、碳酸氢钠及利多卡因膀胱灌注治疗间质性膀胱炎具有创伤小、临床疗效显著、价格低廉等优点,具有一定的推广应用价值。     

碱化利多卡因膀胱灌注治疗氯胺酮相关性膀胱炎

目的 探讨碱化利多卡因膀胱灌注扩张治疗氯胺酮相关性膀胱炎的临床价值.方法 2008-2009年收治氯胺酮相关性膀胱炎7例.男6例,女1例.平均年龄26(19～38)岁.其中复发病例3例共10次.患者均有氯胺酮滥用史,伴有严重尿频、尿急、尿痛等下尿路症状(LUTS);白天排尿间隔时间(20±15)min,夜尿12～20次,每次尿量(50±15)ml.B超检查示膀胱壁增厚、容积缩小;上尿路积水3例.尿动力学检查功能性膀胱容量平均50(20～100)ml,Qmax3.7～10.8 ml/s,残余尿量0～24 ml.膀胱感觉敏感性增高、顺应性下降3例.蛛网膜下腔加硬膜外麻醉下行膀胱镜检查术,见膀胱黏膜呈广泛出血样改变.患者均在麻醉下行膀胱水压扩张、术后留置硬膜外导管镇痛和2%碳酸利多卡因20 ml加5%碳酸氧钠10 ml膀胱灌注并口服清除氧自由基药物等综合治疗.结果 2例膀胱活检提示慢性炎症伴肉芽肿样增生改变.膀胱灌注治疗7～10 d后患者LUTS均明显改善,膀胱容量平均(150±30)ml,排尿间隔(85±25)min,Qmax(11.5±3.8)ml/s,夜尿3～5次.3例复发者重复上述治疗.平均随访7(2～17)个月,患者症状均明显好转,每次排尿量平均(250±80)ml,夜尿0～2次.结果 麻醉状态下以碱化利多卡因膀胱灌注扩张能迅速、有效地增加膀胱容量,改善LUTS,是治疗氯胺酮相关性膀胱炎一种简单有效的方法.     

体外冲击波联合肝素四联药物灌注治疗间质性膀胱炎/膀胱疼痛综合征的疗效观察

目的:观察体外冲击联合肝素+利多卡因+碳酸氢钠+庆大霉素膀胱灌注治疗间质性膀胱炎/膀胱疼痛综合征的临床疗效.方法:61例间质性膀胱炎/膀胱疼痛综合征患者随机分为对照组和观察组,对照组(n =31)采用肝素等四联药物膀胱灌注治疗(肝素、碳酸氢钠、庆大霉素、利多卡因),每周灌注2次,灌注6～8周之后每月2次,共灌注3个月,...     

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。     

中西医结合治疗膀胱疼痛综合征／间质性膀胱炎24例报告

目的：观察中西医结合治疗膀胱疼痛综合征／间质性膀胱炎的治疗效果。方法：选取2009年1月～2011年12月收治的膀胱疼痛综合征／间质性膀胱炎患者24例,采用宁泌泰胶囊联合黛力新进行治疗,统计其治疗前后O＇leary and Sant间质性膀胱炎指数症状指数评分并行t检验。结果：有效23例,总有效率高达96％,疗效确切。结论：采用宁泌泰胶囊联合黛力新治疗膀胱疼痛综合症／间质性膀胱炎疗效确切,副作用少。     

地塞米松联合碱化利多卡因膀胱灌注治疗氯胺酮相关性膀胱炎的疗效观察

【摘要】 目的 观察地塞米松联合碱化利多卡因膀胱灌注治疗氯胺酮相关性膀胱炎的疗效。方法 8例确诊为氯胺酮相关性膀胱炎经戒断吸食氯胺酮、抗生素治疗等常规治疗无效,而拒绝行膀胱水灌注及注射肉毒素的男性患者,用地塞米松及碱化利多卡因行规律膀胱灌注,比较治疗前及治疗1周及3周后患者的排尿情况、OABSS评分等症状改善情况。 结果 8例患者经治疗后症状明显改善,排尿日记显示治疗1周后患者日间排尿次数由(20.5±7.8)次减至(5.6±2.3)次(P<0.05),夜间排尿次数由(15.5±3.2)次减少至(3±1.2)次(P<0.05),尿量由(30.4±12.4)mL/次增加至(50±10.1)mL/次(P<0.05)。OABSS评分由治疗前的(10.7±1.5)分减至治疗后的(5.2±1.3)分(P<0.05)。8例患者均未出现药物不良反应。 结论 地塞米松联合碱化利多卡因膀胱灌注治疗氯胺酮相关性膀胱炎安全、药物普及且费用低,在短期内是有效的,对拒绝行手术治疗的患者,可考虑使用。     

药物联合治疗膀胱疼痛综合征/间质性膀胱炎的疗效及影响因素

目的 探讨膀胱水扩张后,联合应用阿米替林、西米替丁和辣椒辣素类似物(RTX)治疗膀胱疼痛综合征/间质性膀胱炎(PBS/IC)的疗效及影响因素. 方法 以NIDDK诊断标准诊断PBS/IC患者29例.男6例,女23例.年龄(52±14)岁.病程(3.7±1.9)年.10例既往无特殊病史者和7例伴高血压、糖尿病等无关病史者为无伴随疾病组;行膀胱颈内切开(5例)、前列腺电切(3例)和妇科疾病(2例)或妇科手术史(2例)者为伴随疾病组.伴随疾病组病例均为原发疾病治愈后3个月膀胱疼痛症状仍持续存在者,故仍获诊断.治疗方案以麻醉下水扩张为起点,联合膀胱灌注RTX1～2次、口服阿米替林25 mg 1～2次/d及西米替丁800 mg 1次/d.主要疗效指标为治疗前后O'Leary-Sant评分的变化,次要疗效指标包括疼痛评分、每日平均排尿次数及平均每次排尿量,临床随访终点为平均随访时间达到或超过9个月的各项疗效指标. 结果 平均随访(9.2±6.O)个月;随访方案为出院后1个月、6个月及此后每6个月随访1次.治疗总有效率65.5%(19/29),其中症状完全缓解率为41.4%(12/29)、部分缓解率为24.1%(7/29);治疗无效率为34.5%(10/29).治疗前患者平均每日排尿次数(29±15)次、每次排尿量(64±36)ml、O'Leary-Sant评分(23.8±4.8),治疗后分别为(17±12)次、(172±108)ml和13.3±10.4,均较术前显著改善(P值均<0.001).伴随疾病组治疗前平均O'Leary-Sant评分(21.5±4.7)低于无伴随疾病组(25.4±4.3,P=0.030);但其治疗完全缓解率(8.3%,1/12)明显低于无伴随疾病组(64.7%,11/17,P=0.003).Logistic回归分析发现在患者年龄、性别、病程、术前疾病严重程度(按照O'Leary-Sant评分)和是否伴随疾病5项因子中,患者症状改善与否与伴随疾病状态呈负相关(P=0.008,偏回归系数为-3.899,比数比为0.020).结论 膀胱水扩张后,联合阿米替林、西米替丁和RTX治疗PBS/IC疗效良好,但既往伴妇科疾病史者、妇科手术或尿道手术史者疗效不佳.     

微波热疗联合三联药物膀胱灌注治疗膀胱疼痛综合征/间质性膀胱炎的临床研究

目的探讨微波热疗联合三联药物膀胱灌注治疗膀胱疼痛综合征/间质性膀胱炎（BPS/IC）的临床效果与安全性。 方法回顾性分析2014年2月至2017年9月收治的51例BPS/IC患者的临床资料,其中女44例,男7例,平均年龄36岁,平均病程32个月。对照组采用单纯三联药物膀胱灌注,治疗组在膀胱灌注的基础上运用微波热疗治疗。所有患者治疗前后均行O'Leary-Sant间质性膀胱炎症状指数和问题指数评分（ICSI/ICPI）,盆腔疼痛及尿频评分（PUF）和VAS疼痛评分以评估疗效。 结果经治疗后,治疗组患者ICSI、ICPI、PUF及VAS评分均优于对照组[（7.3±3.3） vs（10.7±2.5）、（5.2±3.5）vs（7.5±3.5）、（19.6±3.4）vs（22.3±4.7）、（5.0±0.7）vs（5.8±1.1）,P值均<0.05）],且两组患者治疗后各项评分均优于治疗前（P<0.05）,治疗组患者有效率为91.7%,所有患者均未发生严重不良反应。 结论微波热疗联合药物膀胱灌注治疗BPS/IC的疗效肯定,适合广泛开展,为临床治疗BPS/IC提供了一种有效方法。     

Intravesical hyaluronic acid and alkalinized lidocaine for the treatment of severe painful bladder syndrome/interstitial cystitis

Introduction and hypothesis

Intravesical instillation of hyaluronic acid (HA) may restore the integrity of glycosaminoglycan layer in patients with painful bladder syndrome/interstitial cystitis (PBS/IC), and the benefit may be improved with addition of alkalinized lidocaine (AL).

Methods

48 women with severe PBS/IC who failed oral medications were enrolled and divided into one trial and two control groups. The trial group received intravesical 40?mg HA, 10?ml of 2?% lidocaine and 5?ml of 8.4?% sodium bicarbonate on a weekly basis for 8?weeks and then monthly for 4?months with a subsequent follow-up of 24?weeks, while the two control groups received 40?mg HA and mixture of 10?ml of 2?% lidocaine and 5?ml of 8.4%sodium bicarbonate respectively following the same procedure. Response to therapy was evaluated by Global Response Assessment, voids per day, Visual Analogue Scale for pain, frequency and urgency, O??leary-Sant Interstitial Cystitis Symptom Index and Problem Index, cystoscopy and bladder capacity.

Results

Overall 45 patients finished this study protocol. The HA + AL group and the AL group showed significant improvement at week 2 (P?<?0.01), while the HA group began to show effect at week 4 (P?<?0.01). There was no improvement in the AL group at week 24 and these patients quitted the study without follow up. Contrarily, the HA + AL and HA group kept on improving till the end of the study without significant difference between the two groups.

Conclusions

Intravesical instillation of HA and AL may provide both immediate and sustained relief of symptoms in severe PBS/IC in this preliminary study.     

Intravesical alkalinized lidocaine (PSD597) offers sustained relief from symptoms of interstitial cystitis and painful bladder syndrome

OBJECTIVE

To assess the immediate and sustained relief of the symptoms of interstitial cystitis/painful bladder syndrome (IC/PBlS) after a consecutive 5‐day course of treatment with intravesical alkalinized lidocaine (PSD597), and to characterize the pharmacokinetics of single and multiple doses of intravesical PSD597 in a subgroup of patients.

PATIENTS AND METHODS

In all, 102 adult patients (99 women) with a clinical diagnosis of IC/PBlS were randomized from 19 centres in the USA and Canada to receive a daily intravesical instillation of 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), for 5 consecutive days. Patients were followed at intervals up to 29 days after the first instillation. 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.

RESULTS

Significantly more patients treated with PSD597 rated their overall bladder symptoms as moderately or markedly improved on the GRA scale 3 days after completing the 5‐day course of treatment (30% and 9.6%, respectively, for patients treated with PSD597 and placebo; P = 0.012). The treatment effects were also maintained beyond the end of treatment and are further supported by the secondary endpoints, including symptom and problem indices. The peak serum lidocaine concentration during the study was <2 µg/mL, and well below the toxic level (>5 µg/mL).

CONCLUSION

This preliminary study showed that PSD597 was effective for providing sustained amelioration of symptoms of IC/PBlS beyond the acute treatment phase. The drug was 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.     

Pregnancy and interstitial cystitis/painful bladder syndrome

Painful bladder syndrome (PBS) and interstitial cystitis (IC) often affect women of child-bearing age. This article includes information of interest to PBS/IC patients who are pregnant or contemplating pregnancy, and to the clinicians who care for them. One topic is how pregnancy affects PBS/IC symptoms, although little is known at this time. The article also describes the pregnancy risks associated with the most commonly used PBS/IC treatments. Finally, the current knowledge regarding genetic factors in IC is discussed.     

Urodynamic testing and interstitial cystitis/painful bladder syndrome

Introduction and hypothesis

The objective of this study is to evaluate the relationship between symptom severity in interstitial cystitis/painful bladder syndrome, urodynamic testing (UDT), and cystoscopy.

Methods

Charts of subjects who underwent cystoscopy and bladder overdistention (BOD) from January 2006 to July 2007 were reviewed for data points, questionnaires, UDT, and BOD findings. The independent T test and Mann–Whitney U test were performed between questionnaires, urodynamic data, and cystoscopic findings.

Results

Significantly lower volumes on all UDT parameters and higher scores on the interstitial cystitis problem index and pain Likert scale were found in subjects who felt pain with filling on UDT. Significantly lower median volumes for certain urodynamic parameters were found in subjects with high pain Likert scores and O'leary–Sant indices and those with grade 3 glomerulations and anesthetic bladder capacities of less than 600 mL on BOD.

Conclusion

UDT may be a useful adjunctive test in the evaluation of patients with irritative voiding symptoms.     

Increased bladder permeability in interstitial cystitis/painful bladder syndrome

The definition of interstitial cystitis (IC) has evolved over the years from being a well-defined entity characterized by diagnostic lesion (Hunner’s ulcer) in the urothelium to a clinical diagnosis by exclusion [painful bladder syndrome (PBS)]. Although the etiology is unknown, a central theme has been an association with increased permeability of the bladder. This article reviews the evidence for increased permeability being important to the symptoms of interstitial cystitis/painful bladder syndrome (IC/PBS) and in treating the disorder. Recent work showing cross-communication among visceral organs is also reviewed to provide a basis for understanding IC/PBS as a systemic disorder of a complex, interconnected system consisting of the bladder, bowel and other organs, nerves, cytokine-responding cells and the nervous system.     

Hyaluronan treatment of interstitial cystitis/painful bladder syndrome

The aim of this study is to evaluate the efficacy of intravesical hyaluronan therapy in interstitial cystitis/painful bladder syndrome (IC/PBS). One hundred twenty-six patients with IC/PBS and an average disease duration of 6.1 years were treated with weekly instillations of a 50-cm³ phosphate-buffered saline solution containing 40 mg sodium hyaluronate. To be eligible for hyaluronan treatment, a positive modified potassium test was requested as a sign of a urine–tissue barrier disorder. 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. A positive and durable impact of hyaluronan therapy on IC/PBS symptoms was observed—103 (85%) of the patients reported symptom improvement (≥2 VAS units). The mean initial VAS score of 8.5 decreased to 3.5 after therapy (p < 0.0001). Out of 121 patients, 67 (55%) remained with no or minimal bladder symptoms after therapy (VAS 0–2). The majority (101, 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. 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%.     

膀胱疼痛综合症／间质性膀胱炎研究进展

膀胱疼痛综合症／间质性膀胱炎（painful bladder syndrome／interstitial cystitis,PBS／IC）是一种基于尿频、尿急、膀胱或盆底疼痛的的慢性疼痛综合症。1836年美国费城外科医生JOSEPH PARRISH报告了3例病因不明的有严重下尿路症状的患者并将此疾病命名为“膀胱三叉神经痛”。