Urinary Epitectin (MUC-1 Glycoprotein) in the Menstrual Cycle and Interstitial Cystitis

Purpose

We compared interstitial cystitis and control urine specimens for epitectin (MUC-1 glycoprotein), an epithelial mucin.

Materials and Methods

Urinary epitectin was measured in 28 patients with interstitial cystitis and 26 healthy controls. Ten controls provided multiple urine samples to determine whether urinary epitectin changes with the menstrual cycle.

Results

Epitectin levels were stable throughout the menstrual cycle. Interstitial cystitis cases had decreased urinary epitectin-to-creatinine ratios (mean 3.89 versus 6.38 microgram/mg. creatinine for controls, p = 0.0035) and epitectin concentrations (mean 1.96 versus 4.30 microgram/ml., respectively, p = 0.0005).

Conclusions

Decreased mean urinary epitectin levels may reflect a cause (epithelial mucin deficiency) or a consequence of interstitial cystitis.     

Urinary Chondroitin Sulfates, Heparan Sulfate and Total Sulfated Glycosaminoglycans in Interstitial Cystitis

Purpose

We compared urinary glycosaminoglycan levels in patients with interstitial cystitis and healthy controls.

Materials and Methods

Total sulfated glycosaminoglycans assayed by dimethylmethylene blue binding and individual glycosaminoglycans analyzed by cellulose acetate electrophoresis were compared in patients with interstitial cystitis and healthy controls. Also, multiple urine samples were obtained from healthy female controls for 2 months to assess the relationship of urinary glycosaminoglycan and creatinine concentrations, and to determine whether glycosaminoglycan excretion changes during the menstrual cycle.

Results

Total sulfated glycosaminoglycan and creatinine concentrations correlated well in random voided samples. Menstrual cycle day did not affect total sulfated glycosaminoglycan levels. Cellulose acetate electrophoresis revealed 3 bands corresponding to chondroitin sulfates, heparan sulfate and acidic glycoprotein. Patients with interstitial cystitis had decreased urinary concentrations of each of these individual components and total sulfated glycosaminoglycans. However, glycosaminoglycan-to-creatinine ratios were similar in interstitial cystitis and control urine.

Conclusions

Using these assays total and individual urinary glycosaminoglycan levels normalized to creatinine were not altered in interstitial cystitis.     

Chondroitin Sulphate in the Treatment of Interstitial Cystitis and Chronic Inflammatory Disease of the Urinary Bladder

Objective: To test chondroitin sulphate in patients with interstitial cystitis (IC).Patients and Methods: 24 female patients with the symptom complex frequency/urgency and pain caused by interstitial cystitis were enrolled in the study. Patients suffered between 1 and 20 years from the disease and were all pretreated (hydrodistension, pentosanpolysulphate, anticholinergica). Patients underwent a potassium test as a means of identifying a leaking mucus barrier.Results: Out of 20 patients still under treatment in this ongoing study 12 patients are treated ≥12 months. Improvement of symptoms was reported by all, on average symptom score improved 73%.Conclusion: Chondroitin sulphate was beneficial in patients with pretreated IC.     

Surgical Treatment of Interstitial Cystitis in Women

Interstitial cystitis is a clinical entity that has been known for a century, but its pathophysiology remains largely unknown and the optimal treatment is a matter of ongoing discussion. A successful strategy for treatment relies on precise appraisal of symptoms, clinical findings and histology, as well as on the patient’s individual personality. The least invasive treatment possible should be chosen, and only after conservative options have been exhausted should a surgical solution be considered. In this respect, anatomical bladder capacity plays an important role. A large capacity indicates the potential for conservative treatment and may be regarded as a negative predictor for the outcome of orthotopic bladder substitution. In contrast, a small anatomical capacity is unlikely to respond to conservative therapy, but is associated with a high probability of successful orthotopic bladder substitution.     

A Deficit of Proteoglycans on the Bladder Uroepithelium in Interstitial Cystitis

Physical and immunohistochemical data confirm that the luminal surface of the bladder is richly endowed with proteoglycans. Their likely function is to make the bladder nonadherent and produce a water layer to exclude salts and urinary proteins from the surface. IC patients are shown to have a deficit of chondroitin sulphate from the luminal surface as determined by immunohistochemistry. These studies strongly support previous hypotheses suggesting an etiologic role for loss of barrier function in IC and a rationale for replacement therapy with chondroitin sulphate.     

Urinary excretion of Tamm-Horsfall protein in elderly women

The incidence of urinary tract infection is higher in the geriatric population than in younger adults despite the exclusion of patients with known risk factors. Tamm-Horsfall protein, a renal glycoprotein excreted in urine, may constitute a natural defense mechanism against ascending urinary tract infection by binding mannose-sensitive fimbriated microorganisms. We hypothesized that the quantity of Tamm-Horsfall protein excreted is decreased in the elderly. Native aggregated Tamm-Horsfall protein was measured in urine samples from 24 young women (group 1, mean age 33 years) and 47 female nursing home patients (group 2, mean age 84 years) using enzyme-linked immunosorbent assay techniques. Another 16 elderly women (group 3, mean age 85 years) had active urinary tract infection. The aggregated Tamm-Horsfall protein was then disaggregated by dilution and quantified. Significant differences in mean urinary disaggregated Tamm-Horsfall protein concentrations were found between groups 1 (64.22 mg./l.) and 2 (35.07 mg./l.), and between groups 1 and 3 (34.71 mg./l.), respectively. In contrast, mean aggregated Tamm-Horsfall protein levels were significantly higher in group 2 (1.56 mg./l.) than in group 1 (0.92 mg./l.) or group 3 (0.97 mg./l.). Our studies show that urinary disaggregated Tamm-Horsfall protein concentration is decreased in the elderly, and that aggregated Tamm-Horsfall protein is increased compared to younger adults. The aggregated Tamm-Horsfall protein concentration is decreased in the elderly during episodes of urinary tract infection.     

The Efficacy of Chondroitin Sulphate in Treating Interstitial Cystitis

Objectives: To test in an open label study the response to chondroitin sulphate in patients with the interstitial cystitis syndrome and a positive potassium test.Patients and Methods: Eigtheen patients with interstitial cystitis based on NIH symptom criteria were enrolled in the study. Patients received 40 ml chondroitin sulphate 0.2% instilled intravesically once a week for four weeks and then once a month for 12 months. Quality of life scores, pain and voiding indices were measured baseline and at the final visit. Frequency of voiding was recorded in diaries.Results: 13/18 (66.7%) patients responded with improvement of symptoms, 6/18 (33%) either showed no response or withdrew from the study.Conclusion: Intravesical chondroitin sulphate seems to demonstrate beneficial effects in the treatment of interstitial cystitis patients that have a positive potassium stimulation test.     

Complete Transurethral Resection of Ulcers in Classic Interstitial Cystitis

Interstitial cystitis (IC) is a chronic disease of obscure etiology. It commonly affects females, who present with symptoms of pain on bladder filling and urinary frequency. There are two types of IC: classic and non-ulcer disease, which differ in many respects, including response to different therapies. In this retrospective study we evaluated the hitherto largest series of patients with classic IC treated by transurethral resection (TUR) of visible ulcers. Altogether 259 TURs of Hunner ulcers were performed on 103 patients: 92 experienced amelioration, and in 40% symptom relief lasted more than 3 years. In the remaining patients, although symptom recurrence was common, the majority responded well to subsequent TUR. In conclusion, TUR has a good outcome in patients with classic interstitial cystitis, and we suggest it as first-line treatment in this patient group.