THE EFFICACY OF INTRAVESICAL BACILLUS CALMETTE-GUERIN IN THE TREATMENT OF INTERSTITIAL CYSTITIS: LONG-TERM FOLLOWUP

Purpose

Interstitial cystitis is a severe debilitating bladder disease characterized by unrelenting pelvic pain and urinary frequency. A prospective, double-blind, placebo controlled study of the use of intravesical bacillus Calmette-Guerin (BCG) in the treatment of interstitial cystitis was recently completed with a mean followup of 8 months. Results demonstrated a 60% BCG response rate, compared to a 27% placebo response rate. We now report the long-term followup results of those patients who received intravesical BCG.

Materials and Methods

Subjects randomized to receive BCG were followed at routine intervals with questionnaires and voiding diaries identical to those in the blinded study. Adverse events were closely monitored in the treatment and followup phases of the study. Subject baseline values were compared to followup data.

Results

Of the BCG responders mean followup was 27 months (range 24 to 33), and 8 of 9 (89%) continue to have an excellent response in all parameters measured. The global interstitial cystitis survey improved 70%, daily voids decreased 31%, nocturia improved 54%, mean voided volume increased 61%, pelvic pain decreased 81%, vaginal pain decreased 71%, urgency decreased 71% and dysuria decreased 82%. Overall well-being improved 54% and the Rand-36 quality of life survey overall improved 64%. In 86% of the patients (6 of 7) dyspareunia resolved. Of the initial BCG nonresponders there was no significant difference in interstitial cystitis symptomatology from baseline to last followup, suggesting that BCG does not worsen interstitial cystitis symptoms. No long-term adverse events from BCG were noted.

Conclusions

Intravesical Tice^* BCG is safe, effective and durable in the treatment of interstitial cystitis. Of those patients who received only 6 weekly treatments and responded favorably 89% continue to have an excellent response with followup ranging from 24 to 33 months.     

Enzyme Levels in Semen of Men with Different Types of Azoospermia

The levels of eight enzymes have been measured in the semen of 15 azoospermic subjects. The results indicate that the values of the enzymes Creatine kinase, and Alanine aminotransferase, just as the Aspartate aminotransferase/Alanine aminotransferase ratio are significantly different between excretory and secretory azoospermics. The enzymes Aspartate aminotransferase, Lactate dehydrogenase, alpha-Hydroxybutyrate dehydrogenase, Gammaglutamyl transferase, Acid phosphatase, and Alkaline phosphatase and the alpha-Hydroxybutyrate dehydrogenase/Lactate dehydrogenase ratio have values which do not differ significantly between the two groups of azoospermic men.     

THE EFFECTS OF SOME ANTIDEPRESSANTS ON THE INDUCTION OF MORPHINE DEPENDENCE AND THE MORPHINE WITHDRAWAL SYNDROME

The effects of both acute and chronic administration of theantidepressants mianserin, nomifensine, and (+) and (–)-oxaprotilinewere assessed on naloxone-precipitated abstinence in chronicallymorphinized rats. Chronic coadministration of the antidepressantswith morphine during the induction of dependence produced nosignificant alleviation of withdrawal. Acute administrationof nomifensine prior to precipitation of abstinence with naloxoneproduced an exacerbation of the withdrawal syndrome throughstimulation of supersensitive dopamine receptor sites. By contrast,mianserin and (+)-oxaprotiline produced an overall significantalleviation of withdrawal, whereas (–)-oxaprotiline waswithout effect. The results are discussed in relation to thepossible value of antidepressant treatment during opiate withdrawal.