The ESSIC obtained consensus on a new classification of IC and proposes to replace the name interstitial cystitis (IC) by bladder pain syndrome (BPS) followed by a type indication. In a transition period the name bladder pain syndrome/interstitial cystitis (BPS/IC) could be used parallel with BPS. Click here for more details.
Assessing urgency in interstitial cystitis/painful bladder syndrome. Diggs C, Meyer WA, Langenberg P, et al. Urology 2007;69:210-4 • the O'Leary-Sant Symptom Index appeared to underreport urgency
• asking about urgency "with little or no warning" underestimated the prevalence and degree of urinary urgency
• the authors conclude with the question that may have pathophysiological importance: "why do patients with IC/PBS have urgency ?"
RANTES mediates TNF-dependent lamina propria mast cell accumulation and barrier dysfunction in neurogenic cystitis. Chen MC, Keshavan P, Gregory GD, Klumpp D. Am J Physiol Renal Physiol 2007 Jan 23; [Epub ahead of print]
• this study shows that RANTES plays a key role in the pathogenesis of neurogenic cystitis and suggest that chemokines may represent novel therapeutic targets for IC patients with mast cell-associated disease
(webmaster's comment: RANTES, an acronym for Regulated on Activation - Normal T Expressed and Secreted, is a cytokine that attracts a particular subset of T-lymphocytes and monocytes)
Symptoms of interstitial cystitis, painful bladder syndrome and similar diseases in women: a systematic review. Bogart LM, Berry SH, Clemens JQ. J Urol 2007;177:450-6 • for the purpose of development of a case definition for IC in women, the authors performed a systemic literature review of symptoms of IC, PBS, vulvodynia, pelvic floor dysfunction, overactive bladder, urethral syndrome, various presentations of urinary infections, incontinence (not stress) and various presentations of endometriosis
• the authors conclude that in terms of symptoms:
-
IC and PBS may be the same entity; recurrent urinary tract infections may be distinguished from IC and PBS via a combination of self-report and urine culture information
- IC and PBS may be distinguished from OAB, vulvodynia and endometriosis, although
identifying IC and PBS in women with more than 1 of these diseases may be difficult
The dual serotonin and noradrenaline reuptake inhibitor duloxetine for the treatment of interstitial cystitis: results of an observatinal study. van Ophoven A, Hertle L.J Urol 2007;177:552-5
• in this observational study, duloxetine was given for two months to 48 women with IC according to the NIDDK criteria
• 5 patients (10.4%) responded and 17 (35.4%) dropped out due to nausea as a side effect
• patients who responded reported onset of improvement but not until they had reached the target dose of 2x 40 mg per day
• the authors conclude that
duloxetine did not result in significant improvement of symptoms in patients with IC
not new but important for the discussion on confusable diseases: Dysuria and a headache. Lo S, Noble J, Bowler I, Angus B. Lancet 2004;364:1554 • a case report of a 49-year-old white woman with symptoms of recurrent urinary tract infections; she had no other medical history of note and she had not traveled outside of the UK
• an initial diagnosis of interstitial cystitis was found to be wrong; despite she had no pulmonary disease, the cystitis was found to be due to infection with Mycobacterium tuberculosis
Interstitial cystitis in a woman with systemic mastocytosis. Roth TM. Int Urogynecol J Pelvic Floor Dysfunct 2006 Nov 24; [Epub ahead of print]
• the author describes a patient with systemic mastocytosis who was confirmed to have detrusor mastocytosis and interstitial cystitis
Interleukin-6, histamine, and methylhistamine as diagnostic markers for interstitial cystitis. Lamale LM, Lutgendorf SK, Zimmerman MB, Kreder KJ. Urology 2006;68:702-6
• the authors conclude that a combination of methylhistamine and IL-6 could be used as a sensitive and specific marker for interstitial cystitis; however, the sensitivity of 70.0% and specificity of 72.4% do not seem good enough for their use in clinical practice
Mast cells are essential intermediaries in regulatory T-cell tolerance. Lu LF, Lind EF, Gondek DC, et al. Nature 2006;442:997-1002 • the results show that contrary to the proinflammatory role of mast cells in allergic disorders, mast cells are essential in regulatory T-cell dependent peripheral tolerance
• this papermay form the basis for understanding why mast cells are located in very specific sites within tissues
The molecular basis of urgency: Regional difference of vanilloid receptor expression in the human urinary bladder. Liu L, Mansfield KJ, Kristiana I, et al. Neurourol Urodyn 2006 Oct 2; [Epub ahead of print]
• the authors conclude that symptoms of sensory urgency were associated with the increased expression of targeting vanilloid receptor TRPV1 mRNA in the trigonal mucosa; no upregulation or regional differences of TRPV1 mRNA were seen in idiopathic detrusor overactivity patients
• TRPV1 may play a role in SU and premature first bladder sensation on filling
Prevalence and Correlates for Interstitial Cystitis Symptoms in Women Participating in a Health Screening Project. Temml C, Wehrberger C, Riedl C, et al. Eur Urol 2006 Aug 30; [Epub ahead of print]
• the prevalence of IC in an urban female population was 306/100,000 women
• bowel disorders and psychological stress were correlated to the probability of IC
• the authors conclude that the prevalence of IC symptoms is higher than previously estimated and substantially affects quality of life and sexuality.
Dysuria at onset of interstitial cystitis/painful bladder syndrome in women.
Warren JW, Diggs C, Brown V, et al. Urology 2006 Sep 15; [Epub ahead of print]
• a slight majority of women with IC/PBS reported dysuria at onset of their IC/PBS symptoms
• the available laboratory data have suggested that dysuria may be a sensitive indicator of urinary tract infection at the onset of IC/PBS; however, its specificity is as yet undetermined.
Oral presentations at the 31st Annual IUGA Meeting, Athens, Greece, 6-9 September 2006
abstract 046
There is a low incidence of recurrent bacteriuria in painful bladder syndrome/interstitial cystitis (PBS/IC) patients followed longitudinally. Stanford EJ, McMurphy C. Int Urogynecol J 2006;17(Suppl 2):S85
• the authors conclude that only a small number of PBS/IC patients with UTI symptoms have a positive urine culture (9.4%); the incidence of recurrent UTI is 6.6%
abstract 048
Reducing interstitial cystitis pain via pelvic floor electrostimulation. de Jong P, Radziszewski P, Dobronski P, et al. Int Urogynecol J 2006;17(Suppl 2):S86
• the authors conclude that a significant effect of pelvic floor stimulation (Miniaturo™-1) in pain associated with IC/PBS was demonstrated
• improving this distressing parameter considerably changed the quality of life of the patients
Development of glomerulations in younger women with interstitial cystitis. Shear S, Mayer R. Urology 2006;68:253-6
• the authors conlude that
- interstitial cystitis symptoms can develop before an age where adult urologists or primary care physicians familiar with the diagnosis and treatment are usually involved with care
- the cystoscopic appearance of the bladder wall after hydrodistension may not be constant over time, and that the absence of initial findings of glomerulations or terminal hematuria does not preclude further development of these hallmarks of the disease on subsequent evaluation
Cysteinyl leukotriene D4 increases human detrusor muscle responsiveness to histamine. Bouchelouche K, Bouchelouche P. J Urol 2006;176:361-6 • in this study, it is shown that leukotriene D4 potentiates the effect of histamine in the human detrusor muscle.
• leukotriene D4 and histamine, that are often released concomitantly from mast cells, may interact mutually to potentiate the spasmogenic effect of histamine
• these authors suggest that the combination of leukotriene D4 and histamine H1 receptor antagonists may be more effective for the treatment of interstitial cystitis than when given alone
Transient receptor potential vanilloid receptor subtype 1 in painful bladder syndrome and its correlation with pain. Mukerji G, Yiangou Y, AgarwalSK, Anand P. J Urol 2006;176:797-801
• this study shows increased transient receptor potential vanilloid receptor subtype 1 in nerve fibers of the bladder in painful bladder syndrome and a correlation of the pain score with the relative density of transient receptor potential vanilloid receptor subtype 1 nerve fibers
• the authors conclude that transient receptor potential vanilloid receptor subtype 1 may have a role in the pathophysiology of painful bladder syndrome and it is a potential target for novel therapeutic agents
Efficiency of Questionnaires Used to Screen for Interstitial Cystitis. Kushner L, Moldwin RM. J Urol 2006;176:587-92
• the Pain, Urgency, Frequency Symptom Scale and the O’Leary-Sant Symptom Index and Problem Index were administered to the same 220 patients at a urology clinic before diagnosis
• IC was distinguishable from the other diagnoses using both questionnaires (p<0.001)
• separate analyses of bother and symptom scores yielded similar results
• ROC curves demonstrated the Pain, Urgency, Frequency Symptom Scale to be more efficient than the O’Leary-Sant Symptom Index and Problem Index in detecting interstitial cystitis in this population with an optimal cutoff value of 13 or greater
• the authors conclude that while the Pain, Urgency, Frequency Symptom Scale and the O’Leary-Sant Symptom Index and Problem Index questionnaires distinguish interstitial cystitis from other urinary tract pathologies, neither questionnaire demonstrates sufficient specificity to serve as the sole diagnostic indicator; and further that these questionnaires should not be used to define IC, but can be used to screen patients with urinary tract symptoms to identify those who should be further examined for IC or to follow those who have already been diagnosed
comment:
• only the combined symptoms in the scale and index scores were analysed and not the separate symptoms e.g. pain related to the bladder
Using the International Continence Society's definition of painful bladder syndrome. Warren JW, Meyer WA, Greenberg P, et al. Urology 2006;67:1138-42; discussion 1142-3
• the authors conclude that the ICS definition identified only 91 (66%) of the 138 patients whom study investigators and caregivers diagnosed as having IC/PBS
• furthermore, those who met the ICS definition did not differ in important ways from those who did not
• these observations suggest that the ICS definition may not be sufficiently sensitive; minor modifications of the definition appeared to increase its sensitivity
Clinical aspects and surgical treatment of urinary tract endometriosis: our experience with 31 cases. Antonelli A, Simeone C, Zani D, et al. Eur Urol 2006;49:1093-8. Epub 2006 Apr 4 • the authors conclude that cystoscopy is advisable in women with pelvic endometriosis with lower urinary tract symptoms
• in their hands, partial cystectomy gave the best results when used to treat bladder endometriosis
editorial comment: "Bladder involvement presents with irritative symptoms in more than 70% of patients, which indicates that this condition should be part of the differential diagnosis of interstitial cystitis"
Chondroitin sulfate for interstitial cystitis. Palylyk-Colwell E. Issues Emerg Health Technol 2006 May;(84):1-4
• this review concludes that two non-randomized, uncontrolled pilot studies reported improvements in patient-reported symptoms after the use of chondroitin sulfate for one year
• the author also concludes that prospective, randomized, head-to-head trials are needed to assess the effectiveness of this technology compared with other IC therapies
Lower urinary tract symptoms in female patients with rheumatoid arthritis. Lee KL, Chen MY, Yeh JH, et al. Scand J Rheumatol 2006;35:96-101
• patients with RA were found to have similar urinary complaints when compared to controls; however, those with secondary SS had a greater severity of lower urinary tract symptoms, a finding similar to that observed in patients with primary SS
Urothelial lesion formation is mediated by TNFR1 during neurogenic cystitis. Chen MC, Mudge CS, Klumpp D. Am J Physiol Renal Physiol 2006 Apr 18; [Epub ahead of print] • the authors conclude that mast cell activation and release of TNF drives urothelial apoptosis and lesion formation in a murine neurogenic cystitis model, and they hypothesize that anti-TNF therapy may stabilize bladder barrier function in IC patients
Efficacy of interstitial cystitis treatments: a review. Karsenty G, AlTaweel W, Hajebrahimi S, Corcos J. EAU-EBU Update Series 2006;4:47-61 • in this article, the degree of evidence regarding the clinical efficacy of available interstitial cystitis treatment options is reviewed • only three therapies are supported by a high level of evidence: oral cimetidine and amitriptyline and the intravesical dimethylsulfoxide (DMSO)
Interstitielle Zystitis
Eine wichtige Differentialdiagnose [Interstitial cystitis An important differential diagnosis.] [Article in German] van Ophoven A, Oberpenning F. Urologe A 2006 Mar 14; [Epub ahead of print] - a review on interstitial cystitis in German
Cool and menthol receptor TRPM8 in human urinary bladder disorders and clinical correlations. Mukerji G, Yiangou Y, Corcoran SL, et al. BMC Urol 2006 Mar 6;6(1):6 [Epub ahead of print]
- according to the authors, this study demonstrates increased cold-menthol sensory receptors (TRPM8) in nerve fibres of overactive and painful bladders, and its relationship with clinical symptoms; they suggest that TRPM8 may play a role in the symptomatology and pathophysiology of these disorders, and may provide an additional target for future overactive and painful bladder pharmacotherapy
Keratin expression profiling of transitional epithelium in the painful bladder syndrome/interstitial cystitis.
Laguna P, Smedts F, Nordling J, et al. Am J Clin Pathol 2006;125:105-10
• bladder urothelium in PBS/IC showed distinct differences in the profiles of keratins 7, 8, 14, 17, 18, and 20 compared with literature reports for normal bladder urothelium; whether these changes are primary or secondary to another underlying condition remains to be determined according to the authors note:
• PBS/IC patients fulfilled the NIDDK criteria
• keratins, of which 20 types are known, are the most important parts of the skeleton of the cell
Predictors of symptom severity in patients with chronic prostatitis and interstitial cystitis. Clemens JQ, Brown SO, Kozloff L, Calhoun EA. J Urol 2006;175:963-7 • few common medical conditions were predictive of symptoms severity in this analysis; self-reported pelvic pain symptoms, education and depression severity were the factors most strongly predictive of symptom severity in patients with CP/CPPS and IC
Interstitial
cystitis: cost, treatment and co-morbidities in an employed
population.
Wu EQ, Birnbaum H, Mareva M, et al. Pharmacoeconomics.
2006;24:55-65
• the authors conclude that:
- IC is a costly disease associated
with co-morbidities
- following diagnosis, patients with IC are commonly untreated
or treated with non-approved drug therapies
- it is possible that more accurate diagnosis
and earlier and more appropriate treatment of IC would lead to
better management (or even prevention) of co-morbidities and
reduce healthcare costs, and this should be investigated in future
studies.
A novel highly effective treatment of interstitial cystitis causing chronic pelvic pain of bladder origin: case reports. Check JH, Katsoff B, Citerone T, Bonnes E. Clin Exp Obstet Gynecol 2005;32:247-9
• two women with interstitial cystitis that had been refractory to various therapies were treated with dextroamphetamine sulfate
• both patients quickly improved their bladder symptoms, all pain and urgency was gone within a week and the IC remission as long as the women stayed on their medication
Symptoms and cystoscopic findings in patients with untreated interstitial cystitis.
Lamale LM, Lutgendorf SK, Hoffman AN, Kreder KJ. Urology 2006 Jan 24; [Epub ahead of print]
• in patients with untreated interstitial cystitis, a strong correlation between pain and cystoscopic findings was observed
• the authors explain the differences between their results and those of previous studies (that found no relationship between symptom reports and cystoscopic findings) by possible effects of treatment on pain perception and therapeutic influence on cystoscopic findings
The management of interstitial cystitis: an update. Phatak S, Foster HE. Nat Clin Pract Urol 2006, 3:45-53 • this review aims to cover standard and novel treatment options, while concentrating on the management of pain
A
simple method for teaching about voiding disorders. Steers WD, Gray M. BJU Int 2006;97:237-42 • the authors describe the binomial-type
system that they developed to provide a simple conceptualization
of pathophysiology and treatment strategies for disorders of
the lower urinary tract
Responsiveness
of symptom scales for interstitial cystitis. Propert KJ, Mayer RD, Wang Y, et al. Urology
2006;67:55-9
• the three symptom scales (O'Leary-Sant Symptom and Problem
Indexes, University of Wisconsin Interstitial Cystitis Inventory
and scales that measure individual symptom domains of pain/discomfort,
urgency, and voiding frequency) are responsive to change over time
in patients with
IC
• the authors conclude that these indexes provide important
insight into symptom changes and recommend them as secondary endpoints
in future clinivcal trials of IC
Interstitial
cystitis versus detrusor overactivity: a comparative, randomized,
controlled study of cystometry using saline and 0.3 m potassium
chloride. Philip J, Willmott S, Irwin P. J Urol 2006;175:566-71 • the authors compared cystometric findings in interstitial cystitis (IC)
and detrusor overactivity (DO) using 0.3 M KCl and 0.9% normal saline
• they conclude that
(1) the 0.3 M KCl reduces Cmax in IC and DO, (2) the effect being
more pronounced in DO, (3) urothelial hyperpermeability is not specific to IC
and that (4) comparative cystometry using NS and 0.3 M KCl does not help to differentiate
IC from DO
Interstitial cystitis and infectious agents. Fioriti D, Penta M, Mischitelli M, et al. Int J Immunopathol Pharmacol 2005,18:799-804 • in this case report a 42-year old women with IC is described in whom bladder biopsies revealed a viral co-infection; the authors suggest that this finding could support the hypothesis of a multi-factorial origin of IC. pathology
Chronic pelvic pain: the occurrence of interstitial cystitis in a gynecological population. Paulson JD, Delgado M. JSLS 2005;9:426-30 35 women with chronic pelvic pain underwent laparoscopy and cystoscopy with hydrodistention; 28 patients (80%) were diagnosed with interstitial cystitis, 28 with endometriosis (80%), 24 had both diseases {69%), and 32 (91%) had endometriosis, interstitial cystitis, or both. Three patients (9%) had neither and were diagnosed with other pathologies
Risk
factors for painful bladder syndrome in women seeking gynecologic
care. Kennedy CM, Bradley CS, Galask RP, Nygaard IE. Int Urogynecol
J 2005;17:73-8 • in this survey among 645 women seeking
gynaecologic care, bladder pain was associated with current smoking,
irritable bowel syndrome and a generalized pain disorder
