阿米替林与二甲基亚砜治疗间质性膀胱炎的临床研究

目的探讨口服阿米替林及膀胱灌注二甲基亚砜（DMSO）治疗间质性膀胱炎的临床有效性及安全性。方法2004年7月~2008年5月,采用美国国立肾病、消化病和糖尿病研究所（NIDDK）制定的标准诊断间质性膀胱炎19例,口服阿米替林25mg／d。治疗1周效果不佳的患者加服阿米替林至50mg／d,最大不超过75mg／d。对无效或不能耐受阿米替林副作用的患者加用50％DMSO50mL膀胱灌注连续10次（其中2例用50％DMSO50mL＋1万单位低分子肝素钠灌注）,总疗程3个月。观察指标：O’Leary间质性膀胱炎症状指数、间质性膀胱炎问题指数、视觉疼痛模拟量表及排尿日记。结果19例患者均完成治疗,17例患者取得良好的效果,2例患者效果较差。结论口服阿米替林及膀胱灌注DMSO是治疗间质性膀胱炎简单有效的方法,可以缓解患者的临床症状,提高生活质量,其副作用可以被大多数患者耐受。     

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。     

躯体功能及总体健康感在女性间质性膀胱炎治疗过程中的变化

目的探讨间质性膀胱炎（IC）治疗前后躯体功能（PF）及总体健康感（GH）的变化。方法2005年5月-2009年5年,依据症状及膀胱镜检查诊断间质性膀胱炎31例,其中23例符合美国国立糖尿病、消化病和。肾病研究所（NIDDK）的诊断标准。所有患者开始均口服阿米替林25mg,1次／d。治疗一周效果不佳者加服阿米替林至50mg／d,最大不超过100mg／d。对效果不佳或不能耐受阿米替林副作用的患者加用500g／L二甲基亚砜50mL膀胱灌注连续10次（其中4例用500g／L二甲基亚砜50mL＋10000u低分子肝素钠灌注）,总疗程3个月。观察指标：O’Leary间质性膀胱炎症状指数及问题指数、PF及GH。结果31例患者均完成治疗,25例患者取得良好的效果,6例患者效果较差。结论随着女性IC患者病情好转其躯体功能得到改善,患者的总体健康满意度提高。     

A rational combination of intravesical and systemic agents for the treatment of interstitial cystitis

OBJECTIVE: Interstitial cystitis is a condition with a poorly understood etiology and, consequently, various treatment options have been described in the literature, with a less than optimal outcome. The aim of this study was to examine the role of a combination of intravesical hydrocortisone and heparin, together with oral bladder sedatives and systemic triamcinolone, for the treatment of interstitial cystitis. MATERIAL AND METHODS: A total of 26 patients who were diagnosed as having interstitial cystitis were treated with weekly intravesical hydrocortisone (200 mg) and heparin (25,000 IU) in physiological saline for 6 weeks. In addition, they were given oral bladder sedatives such as oxybutynin or tolterodine. Ulcerative, refractory and recurrent cases were treated with intramuscular triamcinolone (40 mg) weekly for 6 weeks. RESULTS: All patients experienced an improvement in symptoms within 48 h of their first intravesical instillation. While 19 patients (73%) experienced almost complete pain relief, five of the remaining seven patients improved with intramuscular triamcinolone. Frequency reduced from a mean of 23.2 to 10.9 voids per day and was acceptable in 21 patients (80%). Six patients (23%) had a relapse of symptoms in the form of pain and were treated satisfactorily by means of intramuscular triamcinolone. The mean duration of follow-up was 18.3 months. CONCLUSION: A combination of intravesical hydrocortisone and heparin, along with oral bladder sedatives and systemic steroids, has been used with encouraging results in a small group of patients with interstitial cystitis.     

Efficacy of oral doxepin and piroxicam treatment for interstitial cystitis

OBJECTIVE: To establish the efficacy of a multidrug oral treatment with the tricyclic antidepressant agent doxepin and the cyclooxygenase (COX) inhibitor piroxicam in patients with interstitial cystitis (IC), who had failed standard therapy in an open, prospective, nonrandomized study. METHODS: A total of 37 patients diagnosed with IC received 75 mg doxepin and 40 mg piroxicam daily. The treatment was termed DOXCAM. Effectiveness of therapy was assessed with frequency-volume charts, an IC symptom score and with cystometry prior to treatment, 8 weeks after the start and 4 weeks after termination of drug treatment. RESULTS: Medication was not tolerated by five patients. Twenty-six of 32 patients have experienced virtual total remission of symptoms (81%) and six patients had significant relief (19%). DOXCAM treatment resulted in a significant percent decrease in pain (65% versus 21%). Daytime frequency decreased from 17.6+/-5.7 to 11.3+/-3.6 voids while nocturia did not improve significantly. Twenty-three of the 26 patients who became symptom free and four of the six patients who showed significant improvement had a return of symptoms after cessation of therapy. CONCLUSION: It is reasonable to consider oral treatment with DOXCAM in those patients who have failed first-line therapies.     

Treatment of interstitial cystitis with the neodymium-YAG laser

Five patients with severe interstitial cystitis that had not responded to conventional means of therapy were treated with the neodymium-YAG laser. Of the 5 patients 4 demonstrated cessation of severe bladder pain and frequency of urination within several days after therapy. These patients also were studied objectively by measuring bladder capacity, which was found to be increased over-all. Complication rates from this modality of therapy were extremely low. The patients have been followed for 3 to 15 months after treatment and to date have had no recurrent symptoms of severe interstitial cystitis, although some have had mild recurrent voiding symptoms.     

Interstitial cystitis: how should we diagnose it and treat it in 2004?

PURPOSE OF REVIEW: During the last 2 years, two international and two European meetings have taken place and a European Society formed dealing only with interstitial cystitis. A separate committee for interstitial cystitis was formed during the last WHO International Consensus Meeting on urinary incontinence. As a consequence, new concepts and recommendations are evolving, for example the nomenclature is changing from interstitial cystitis to painful bladder syndrome/interstitial cystitis. RECENT FINDINGS: At an international meeting in Kyoto, the scientific basis for diagnosis and treatment of painful bladder syndrome/interstitial cystitis was reviewed, confirming the poor evidence for many diagnostic procedures and treatments. There are two main reasons for this: an internationally accepted definition is lacking and the disease is rare, making clinical trials difficult. A meeting in Copenhagen resulted in a standardization of the procedures for evaluation and the creation of a European Society for the Study of Interstitial Cystitis. Increased concentration of nitric oxide in the urine of patients with Hunner's ulcer may help to separate ulcer from non-ulcer patients. A prospective, randomized, placebo-controlled multicenter study failed to show a statistically significant effect of the antihistamine hydroxine or pentosan polysulfate sodium compared with placebo. The study confirmed the difficulties in recruiting patients for large-scale trials, which could be one of the reasons for the negative result. The effect of the traditional treatment with amitriptyline was confirmed in a prospective, placebo-controlled study. SUMMARY: Standardized evaluation of patients with painful bladder syndrome/interstitial cystitis will benefit both patients and science. An internationally accepted definition of the condition appears to be in sight, which will make epidemiological and research studies easier.     

A prospective, randomized, placebo controlled, double-blind study of amitriptyline for the treatment of interstitial cystitis

PURPOSE: We conducted a prospective study to examine the safety and efficacy of the tricyclic antidepressant amitriptyline in patients with interstitial cystitis (IC). MATERIALS AND METHODS: The study comprised 44 women and 6 men who all met the symptom criteria of the National Institute of Diabetes, Digestive and Kidney Diseases for IC. The patients were randomly assigned to amitriptyline or placebo. Patients were prospectively treated for 4 months with a self-titration protocol that allowed them to escalate drug dosage in 25 mg increments in 1 week-intervals (maximum dosage 100 mg). The change from baseline in the O'Leary-Sant IC symptom and problem index was the primary outcome parameter. Changes in functional bladder capacity and frequency (48-hour voiding log), and intensity of pain and urgency (visual analog scales) were chosen as secondary outcome parameters. RESULTS: Two patients (1 on amitriptyline, 1 on placebo) dropped out of the study due to side effects. Thus, the data of 48 patients (24 patients in each group) were available for evaluation. Mean symptom score decreased from 26.9 to 18.5 in the amitriptyline group compared with 27.6 to 24.1 in the placebo group (p = 0.005). Pain and urgency intensity improved statistically significantly in the amitriptyline group compared with the placebo group (p <0.001). The frequency and functional bladder capacity improved to a much greater degree in the amitriptyline group but the differences were not statistically significant (p = 0.063, p = 0.083). Anticholinergic side effects were reported by all except 2 patients in the amitriptyline group (92%) and by 5 patients in the placebo group (21%). Mouth dryness was the most frequent side effect reported in the amitriptyline group (79%). CONCLUSIONS: Amitriptyline therapy for 4 months is safe and effective for treating IC. A statistically significant change in the symptom score and statistically significant improvement of pain and urgency intensity compared with placebo were observed. Anticholinergic side effects constitute the major drawback of amitriptyline treatment for IC.     

The association of elevated urinary total to sulfated glycosaminoglycan ratio and high molecular mass hyaluronic acid with interstitial cystitis

PURPOSE: A decrease in the glycosaminoglycan (GAG) layer on the urothelium is believed to be one of the possible causes of interstitial cystitis. Consequently, GAG-like substances and hyaluronic acid (HA) have been prescribed for treating this condition. To delineate the possible role of GAG and HA in the interstitial cystitis disease process, we compared the urinary levels of total GAGs (sulfated + non-sulfated), sulfated GAGs and HA in interstitial cystitis patients and normal controls. We also examined different HA species present in the urine of interstitial cystitis patients. MATERIALS AND METHODS: The total GAG and sulfated GAG levels in urine specimens of normal individuals (n = 20) and interstitial cystitis patients (n = 25) were determined by utilizing the carbazole reaction assay and the Farndale method, respectively, and were expressed as microg./mg. creatinine. Urinary HA levels were measured by applying the HA test and were expressed as ng./mg. creatinine. Gel filtration column chromatography was used to examine the profile of urinary GAGs and HA species. RESULTS: Total urinary GAGs were 2.5 to 4-fold elevated in interstitial cystitis patients with moderate to severe symptoms (Group 2; 76.2 +/- 24.8) when compared with those in normal individuals (19.9 +/- 2.5) and patients with mild symptoms (Group 1; 30.4 +/- 5.1) (p <0.001). Three urinary GAG peaks were detected in both normal and interstitial patients. However, each GAG peak from interstitial cystitis patient urine was 3 to 5-fold higher than that from normal patient urine. The sulfated GAG levels, however, remained unchanged among normal individuals (1.4 +/- 0.22), Group 1 (2.2 +/- 0.96) and Group 2 (1.6 +/- 0.38) patients (p >0.05). Consequently, the ratio of total GAGs to sulfated GAGs was elevated 3 to 3.5-fold in Group 2 patients (49.9 +/- 13.9) in comparison to that in normal individuals (16.7 +/- 2.5) and group 1 patients (14.4 +/- 4.6) (p <0.001). Urinary HA levels were marginally elevated in Group 2 patients (821. 4 +/- 247.9) when compared with those in the normal group (337.3 +/- 106.1) and Group 1 patients (540.9 +/- 166.5). In addition, a distinct high molecular mass HA species was present only in Group 2 patients. CONCLUSIONS: The increased ratio of total GAGs to sulfated GAGs and marginally elevated HA levels in urine indicate that the GAG layer is altered in interstitial cystitis patients. However, these results are in contrast to the accepted concept that a reduction in urothelial GAGs causes interstitial cystitis. The high molecular mass HA species detected in patients with severe symptoms may play a role in the pathophysiology of this disease.     

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.     

Sacral neuromodulation for the symptomatic treatment of refractory interstitial cystitis: a prospective study

PURPOSE: The efficacy of sacral neuromodulation for the treatment of symptoms in patients with refractory interstitial cystitis was evaluated. MATERIALS AND METHODS: A total of 25 patients with a mean age of 47 years and refractory interstitial cystitis were prospectively evaluated with a trial of sacral nerve stimulation. Patients who demonstrated 50% improvement in frequency, nocturia, voided volume and average pain qualified for permanent sacral nerve stimulator implantation. Treatment success was measured by voiding diary, report of average pain, and response to the Interstitial Cystitis Symptom Index and Interstitial Cystitis Problem Index. RESULTS: Of the 25 patients 17 qualified for permanent sacral nerve stimulator implantation. At an average of 14 months followup mean daytime frequency and nocturia improved from 17.1 to 8.7 and 4.5 to 1.1, respectively (p <0.01). Mean voided volume increased from 111 to 264 ml. (p <0.01). Report of average pain decreased from 5.8 to 1.6 points on a scale of 0 to 10 (p <0.01). Interstitial Cystitis Symptom and Problem Index scores decreased from 16.5 to 6.8 and 14.5 to 5.4, respectively (p <0.01). Of the 17 patients 16 (94%) with a permanent stimulator demonstrated sustained improvement in all parameters at the last postoperative visit. CONCLUSIONS: Results of this prospective clinical study demonstrate that sacral neuromodulation is a safe and effective treatment for the dysfunctional voiding and pelvic pain in patients with interstitial cystitis who are refractory to other forms of treatment.     

阿米替林治疗间质性膀胱炎的临床研究

目的 探讨阿米替林治疗间质性膀胱炎的有效性和安全性. 方法 采用前瞻性研究.间质性膀胱炎患者54例,病程19～72个月,平均(40.7±11.6)个月.口服阿米替林治疗,起始剂量25 mg/次,每晚1次.1周后,若症状不缓解,可加量至50 mg/次;再观察1周,若症状仍不缓解,则可加量至75 mg/次;维持能够缓解症状的最小剂量,总疗程3个月.观察用药前及用药3个月后患者的临床症状(每日排尿次数、最大排尿容量、尿痛程度评分)和O'Leary-Sant间质性膀胱炎问卷表评分及生活质量评分情况.并记录不良反应发生情况. 结果 ①用药3个月后每日排尿次数明显减少,治疗前后分别为(28.5±8.4)和(15.6±3.3)次;最大排尿容量明显增加,治疗前后分别为(108.7±62.2)和(171.0±53.9)ml;尿痛程度评分明显下降,治疗前后分别为6.4±1.5和2.2±1.5,上述指标用药前后相比,差异均有统计学意义(P<0.01).②患者用药3个月后问卷评分和生活质量评分均明显减少,治疗前后分别为26.9±4.0和13.7±5.7及5.5±0.5和2.5±0.6;用药前后比较,差异有统计学意义(P<0.01).③45例在服药第1个月内有不同程度的困倦,43例1个月后自行缓解,2例由于困倦严重且不能缓解而停药.10例服药3个月后体质量增加(5.8±1.8)kg.11例有轻度便秘症状,可以耐受.9例有口干症状,可以耐受.3例出现重度排尿困难,停药后改为其他方法治疗. 结论 阿米替林口服治疗能有效缓解间质性膀胱炎患者的临床症状,改善生活质量,且耐受性及安全性好.     

Effect of comestibles on symptoms of interstitial cystitis

PURPOSE: Anecdotal evidence suggests that patients with painful bladder syndrome/interstitial cystitis report symptom exacerbation after consuming particular foods, beverages and/or supplements. We determined the prevalence of the effect of comestibles on painful bladder syndrome/interstitial cystitis symptoms and identified particular comestible items more likely to affect such symptoms. MATERIALS AND METHODS: A validated questionnaire designed to detect whether food, beverages and/or supplements have an effect on bladder symptoms was administered to 104 patients meeting National Institute for Diabetes and Digestive and Kidney Diseases criteria for interstitial cystitis. In addition to answering general questions about the effect of comestibles on painful bladder syndrome/interstitial cystitis symptoms, subjects were asked to indicate whether each of 175 individual items worsened, improved or had no effect on symptoms. Each response was numerically scored on a scale of -2 to 2 and mean values were generated for each comestible item. RESULTS: Of the surveyed patients with painful bladder syndrome/interstitial cystitis 90.2% indicated that the consumption of certain foods or beverages caused symptom exacerbation. There was no correlation between allergies and the effect of comestibles on symptoms. Patients who reported that specific foods worsened symptoms tended to have higher O'Leary-Sant interstitial cystitis symptom index and problem index, and/or pelvic pain and urgency/frequency patient symptom scale scores. A total of 35 comestible items had a mean score of lower than -1.0, including caffeinated, carbonated and alcoholic beverages, certain fruits and juices, artificial sweeteners and spicy foods. CONCLUSIONS: There is a large cohort of patients with painful bladder syndrome/interstitial cystitis in whom symptoms are exacerbated by the ingestion of specific comestibles. The most frequently reported and most bothersome comestibles were coffee, tea, soda, alcoholic beverages, citrus fruits and juices, artificial sweeteners and hot pepper.     

Pilot study of sequential oral antibiotics for the treatment of interstitial cystitis

PURPOSE: Interstitial cystitis is a chronic disease of unknown etiology characterized by bladder pain, urgency and frequency. Although a single microbe has not been implicated as a cause of interstitial cystitis, several groups noted various organisms in the urine of some women with interstitial cystitis and some patients reported that antibiotics decrease symptoms. Consequently we performed a prospective, randomized, double-blinded, placebo controlled pilot study of sequential oral antibiotics. MATERIALS AND METHODS: We randomized 50 patients with interstitial cystitis to receive 18 weeks of placebo or antibiotics, including rifampin plus a sequence of doxycycline, erythromycin, metronidazole, clindamycin, amoxicillin and ciprofloxacin for 3 weeks each. RESULTS: Intent to treat analysis demonstrated that 12 of 25 patients (48%) in the antibiotic and 6 of 25 (24%) in the placebo group reported overall improvement (p = 0.14), while 10 and 5, respectively, noticed improvement in pain and urgency (p = 0.22). In the antibiotic group 20 participants (80%) had adverse effects compared with 10 (40%) in the placebo group (p = 0.009). CONCLUSIONS: Our findings suggest that these antibiotics alone or in combination may sometimes be associated with decreased symptoms in some patients but they do not represent a major advance in therapy for interstitial cystitis.     

The management of chronic interstitial cystitis by substitution cystoplasty

A total of 19 patients with interstitial cystitis symptoms intractable to conservative management underwent supratrigonal excision of the symptomatic bladder. Reconstruction to produce a low pressure reservoir was accomplished with a segment of remodeled intestine anastomosed to the bladder remnant. Patients were selected because of a history of typical intractable severe symptoms in the presence of characteristic endoscopic features. Of the patients 12 were cured of the pain and frequency, 4 experienced improvement, and 3 failed to improve and underwent urinary diversion. Preoperative features did not predict the outcome, although poor results occurred more often in those with large preoperative bladder capacities while under anesthesia and those who had postoperative voiding problems requiring self-catheterization.     

INCREASED URINARY HYALURONIC ACID AND INTERSTITIAL CYSTITIS

Purpose

We compared urinary levels of hyaluronic acid in patients who met the National Institute for Diabetes, and Digestive and Kidney Diseases criteria for interstitial cystitis and in age matched healthy female controls.

Materials and Methods

Urinary hyaluronic acid was measured by solid phase radiometric assay using hyaluronic acid binding protein. Hyaluronic acid and symptom scores were compared in interstitial cystitis patients who gave multiple urine samples during treatment. Since hyaluronic acid changed with treatment in some patients, 17 samples from untreated interstitial cystitis patients were selected and compared with 17 control samples.

Results

Mean plus or minus standard deviation urinary hyaluronic acid concentrations were similar in the 2 groups (interstitial cystitis group 574 ± 496, controls 512 ± 324 ng./ml., p = 0.77). When normalized to creatinine urinary hyaluronic acid was significantly higher in interstitial cystitis patients (interstitial cystitis group 674 ± 220, controls 446 ± 220 ng./mg. creatinine, p = 0.0019). Urinary creatinine concentrations did not differ significantly (interstitial cystitis group 842 ± 715, controls 1,162 ± 516 mg./l., p = 0.12).

Conclusions

Urinary hyaluronic acid was higher in interstitial cystitis patients than healthy controls. Since bladder hyaluronic acid is below the epithelium, this finding may indicate leakage across the epithelium into the urine in interstitial cystitis patients.     

PELVIC FLOOR MYOFASCIAL TRIGGER POINTS: MANUAL THERAPY FOR INTERSTITIAL CYSTITIS AND THE URGENCY-FREQUENCY SYNDROME

PURPOSE: The effectiveness of manual physical therapy was evaluated in patients with interstitial cystitis and the urethral syndrome, that is urgency-frequency with or without pelvic pain. The rationale was based on the hypothesis that pelvic floor myofascial trigger points are not only a source of pain and voiding symptoms, but also a trigger for neurogenic bladder inflammation via antidromic reflexes. MATERIALS AND METHODS: From September 1995 to November 2000, 45 women and 7 men, including 10 with interstitial cystitis and 42 with the urgency-frequency syndrome, underwent manual physical therapy to the pelvic floor for 1 to 2 visits weekly for 8 to 12 weeks. Results were determined by patient completed symptom score sheets indicating the rate of improvement according to outcome parameters, including 25% to 50%-mild, 51% to 75%-moderate, 76% to 99%-marked and 100%-complete resolution. In 10 cases these subjective results were confirmed by measuring resting pelvic floor tension by electromyography before and after the treatment course. RESULTS: Of the 42 patients with the urgency-frequency syndrome with or without pain 35 (83%) had moderate to marked improvement or complete resolution, while 7 of the 10 (70%) with interstitial cystitis had moderate to marked improvement. The mean duration of symptoms before treatment in those with interstitial cystitis and the urgency-frequency syndrome was 14 (median 12) and 6 years (median 2.5), respectively. In patients with no symptoms or brief, low intensity flares mean followup was 1.5 years. In 10 patients who underwent electromyography mean resting pelvic floor tension decreased from 9.73 to 3.61 microV., which was a 65% improvement. CONCLUSIONS: Pelvic floor manual therapy for decreasing pelvic floor hypertonus effectively ameliorates the symptoms of the urgency/frequency syndrome and interstitial cystitis.     

Early Identification of Interstitial Cystitis May Avoid Unnecessary Hysterectomy

Background:

Interstitial cystitis is a clinical syndrome characterized by symptoms of pelvic pain, urinary urgency and frequency, and nocturia. It can be difficult to accurately identify interstitial cystitis because the symptoms overlap many other common gynecologic and urologic conditions. Patients with undiagnosed interstitial cystitis may undergo unnecessary procedures, including hysterectomy.

Methods:

A PubMed literature search for articles dating back to 1990 was conducted on the topics of interstitial cystitis and hysterectomy. Further references were identified by cross-referencing the bibliographies in articles of interest.

Results:

The literature review found that hysterectomy is performed more often in patients with undiagnosed interstitial cystitis than in patients with a confirmed diagnosis. Interstitial cystitis often coexists with conditions like endometriosis, for which hysterectomy is indicated. Many patients subsequently diagnosed with interstitial cystitis continue to experience persistent pelvic pain despite having had a hysterectomy for chronic pelvic pain. Careful history and physical examination can identify the majority of interstitial cystitis cases.

Conclusion:

Interstitial cystitis should be considered prior to hysterectomy in women who present with pelvic pain or who experience pelvic pain after a hysterectomy. If interstitial cystitis is diagnosed, appropriate therapy may eliminate the need for hysterectomy.     

Intravesical potassium sensitivity in patients with prostatitis

PURPOSE: Prostatitis and interstitial cystitis encompass similar symptoms and may be manifestations of a single pathophysiological process in the lower urinary tract. Most patients with interstitial cystitis have urinary epithelial dysfunction, as indicated by a positive intravesical potassium sensitivity test. We used the potassium sensitivity test for the presence of epithelial dysfunction in men with diagnosed prostatitis. MATERIALS AND METHODS: We administered the potassium sensitivity test in men who presented with the signs and symptoms of prostatitis (urgency/frequency and/or pelvic pain) after being diagnosed with prostatitis and receiving at least 1 course of antibiotic treatment administered by a urologist other than one of us. We also surveyed the patients for urinary symptoms and pain locations using 2 self-evaluation questionnaires. RESULTS: A total of 44 patients with prostatitis completed the questionnaires and underwent the potassium sensitivity test. Of the 44 men 37 (84%) had positive potassium sensitivity test results, 89% reported urinary urgency/frequency and 82% reported pain. Pain locations included the perineum, lower abdomen, lower back, penis, testes, scrotum and rectum as well as dysuria and post-void pain. Pain with sexual intercourse was reported by 75% of the patients with prostatitis. CONCLUSIONS: The rate of positive potassium sensitivity test results in patients with prostatitis is almost identical to that reported in those with interstitial cystitis (84% and 79%, respectively), suggesting that prostatitis and interstitial cystitis may be a continuum of lower urinary epithelial dysfunction. Similar to patients with interstitial cystitis, most patients with prostatitis experience pain during sexual intercourse and perceive pain at locations throughout the pelvis. We suggest reclassifying the prostatitis-interstitial cystitis disease process as lower urinary dysfunctional epithelium.     

Percutaneous sacral nerve root neuromodulation for intractable interstitial cystitis

PURPOSE: We evaluated the efficacy of percutaneous sacral nerve root neuromodulation in women with refractory interstitial cystitis. MATERIAL AND METHODS: We prospectively evaluated 15 consecutive women with a mean age of 62 years who had refractory interstitial cystitis to determine the efficacy of percutaneous stimulation of the S3 sacral roots. The mean duration of symptoms before evaluation was 5.2 years. All women fulfilled the National Institute of Arthritis, Diabetes and Digestive and Kidney Diseases criteria for the diagnosis of interstitial cystitis and were unresponsive to standard oral or intravesical therapy. The response to treatment was assessed using pain scores, urinary diary variables and quality of life surveys. RESULTS: Mean voided volume during treatment increased from 90 to 143 ml. (p <0.001). Mean daytime frequency and nocturia decreased from 20 to 11 and 6 to 2 times (p = 0.012 and 0.007, respectively). Mean bladder pain decreased from 8.9 to 2.4 points on a scale of 0 to 10 (p <0.001). As indicated by the Short Urinary Distress Inventory and SF-36 Health Survey, the quality of life parameters of social functioning, bodily pain and general health significantly improved during the stimulation period. Of the women 73% requested to proceed to complete sacral nerve root implantation. CONCLUSION: Women with intractable interstitial cystitis respond favorably to percutaneous sacral stimulation with significant improvement in pelvic pain, daytime frequency, nocturia, urgency and average voided volume. Permanent sacral implantation may be an effective treatment modality in refractory interstitial cystitis but further long-term evaluation is required.