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Encrusted and incarcerated urinary bladder catheter: what are the options?
CCK Ho, Y Khandasamy, P Singam, E Hong Goh, ZM Zainuddin
Libyan Journal of Medicine , 2010,
Abstract: Urinary bladder catheter encrustations are known complications of long-term urinary catheterisation, which is commonly seen in clinical practice. These encrustations can impede deflation of the balloon and therefore cause problems in the removal of the catheter. The options in managing an encrusted and incarcerated urinary bladder catheter include extracorporeal shock wave lithotripsy and lithoclast. We describe here another technique of dealing with a stuck and encrustated catheter, via direct crushing of the encrustations with a rigid cystoscope inserted through a suprapubic cystostomy tract.
Urinary proteomics evaluation in interstitial cystitis/painful bladder syndrome: a pilot study
Goo, Young Ah;Tsai, Yihsuan S.;Liu, Alvin Y.;Goodlett, David R.;Yang, Claire C.;
International braz j urol , 2010, DOI: 10.1590/S1677-55382010000400010
Abstract: purpose: interstitial cystitis/painful bladder syndrome (ic/pbs) is characterized by chronic pain, pressure and discomfort felt in the pelvis or bladder. an in-depth shotgun proteomics study was carried out to profile the urinary proteome of women with ic/pbs to identify possible specific proteins and networks associated with ic/pbs. materials and methods: urine samples from ten female ic/pbs patients and ten female asymptomatic, healthy control subjects were analyzed in quadruplicate by liquid chromatography-tandem mass spectrometry (lc-ms/ms) on a hybrid linear ion trap-orbitrap mass spectrometer. gas-phase fractionation (gpf) was used to enhance protein identification. differences in protein quantity were determined by peptide spectral counting. results: a-1b-glycoprotein (a1bg) and orosomucoid-1 (orm1) were detected in all ic/pbs patients, and = 60% of these patients had elevated expression of these two proteins compared to control subjects. transthyretin (ttr) and hemopexin (hpx) were detected in all control individuals, but = 60% of the ic/pbs patients had decreased expression levels of these two proteins. enrichment functional analysis showed cell adhesion and response to stimuli were down-regulated whereas response to inflammation, wounding, and tissue degradation were up-regulated in ic/pbs. activation of neurophysiological processes in synaptic inhibition, and lack of dna damage repair may also be key components of ic/pbs. conclusion: there are qualitative and quantitative differences between the urinary proteomes of women with and without ic/pbs. we identified a number of proteins as well as pathways/networks that might contribute to the pathology of ic/pbs or result from perturbations induced by this condition.
Decrease of Urinary Nerve Growth Factor but Not Brain-Derived Neurotrophic Factor in Patients with Interstitial Cystitis/Bladder Pain Syndrome Treated with Hyaluronic Acid  [PDF]
Yuan-Hong Jiang, Hsin-Tzu Liu, Hann-Chorng Kuo
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0091609
Abstract: Aims To investigate urinary nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) levels in interstitial cystitis/bladder pain syndrome (IC/BPS) patients after hyaluronic acid (HA) therapy. Methods Thirty-three patients with IC/BPS were prospectively studied; a group of 45 age-matched healthy subjects served as controls. All IC/BPS patients received nine intravesical HA instillations during the 6-month treatment regimen. Urine samples were collected for measuring urinary NGF and BDNF levels at baseline and 2 weeks after the last HA treatment. The clinical parameters including visual analog scale (VAS) of pain, daily frequency nocturia episodes, functional bladder capacity (FBC) and global response assessment (GRA) were recorded. Urinary NGF and BDNF levels were compared between IC/BPS patients and controls at baseline and after HA treatment. Results Urinary NGF, NGF/Cr, BDNF, and BDNF/Cr levels were significantly higher in IC/BPS patients compared to controls. Both NGF and NGF/Cr levels significantly decreased after HA treatment. Urinary NGF and NGF/Cr levels significantly decreased in the responders with a VAS pain reduction by 2 (both p < 0.05) and the GRA improved by 2 (both p < 0.05), but not in non-responders. Urinary BDNF and BDNF/Cr did not decrease in responders or non-responders after HA therapy. Conclusions Urinary NGF, but not BDNF, levels decreased significantly after HA therapy; both of these factors remained higher than in controls even after HA treatment. HA had a beneficial effect on IC/BPS, but it was limited. The reduction of urinary NGF levels was significant in responders, with a reduction of pain and improved GRA.
Bladder substitution by ileal neobladder for women with interstitial cystitis
Kochakarn, Wachira;Lertsithichai, Panuwat;Pummangura, Wipaporn;
International braz j urol , 2007, DOI: 10.1590/S1677-55382007000400005
Abstract: objective: to report our experience with cystectomy and ileal neobladder for women with interstitial cystitis (ic). materials and methods: thirty-five female patients treated during 2000-2005 with the mean age of 45.9 ± 4.4 years were included in this study. all of them had experience suprapubic pain with irritative voiding symptoms and were diagnosed as having ic based on niddk criteria for at least 2 years. conservative treatments had failed to relieve their symptoms; and therefore all of them agreed to undergo a bladder removal. for cystectomy, the urethra was cut 0.5 cm below the bladder neck, proximal to the pubourethral ligament, leaving the endopelvic fascia intact. an ileal segment of 65 cm was used to create the neobladder with the studer's technique. results: all patients presented good treatment outcome with regard to both diurnal and nocturnal urinary control without any pain. quality of life using the sf-36 questionnaire showed significant improvement of both physical health and mental health. spontaneous voiding with minimal residual urine was found in 33 cases (94.3%), and the remaining 2 cases (5.7%) had spontaneous voiding with residual urine and were placed on clean intermittent catheterization (cic). twelve out of 30 cases with sexually active ability had a mild degree of dyspareunia but without disturbance to sexual life. conclusion: bladder substitution by ileal neobladder for women who suffer from ic can be a satisfactory option after failure of conservative treatment. resection of the urethra distal to the bladder neck can preserve continence and allow spontaneous voiding in almost all patients.
Urinary peritonitis caused by gangrenous cystitis
BOUBAKER CHARRA,ABDELHAMID HACHIMI,MUSTAPHA SODKI,HOUDA GUEDDARI
Signa Vitae , 2008,
Abstract: We report a case of a young man who developed severe urinary sepsis, on the 21st day of hospitalization (DH), which was treated with ciprofloxacin and gentamicin. On the 30th DH, he developed bloodstream and urinary infections due to Acinetobacter baumannii which had been treated with colistin and rifampicin. On the 55th DH, he developed urinary peritonitis and necrosis of the anterior and posterior bladder wall. Bilateral ureterostomy was performed. The patient was treated with colistin and imipenem. Peritoneal fluid culture yielded Enterobacter cloacae susceptible to imipenem. An enterocystoplasty was performed. The outcome was favourable.
Cystitis Glandularis: A Rare Benign Condition Presenting as Bladder Tumor  [PDF]
Sumba Harrison, Hamza Lamchahab, Jacquet Djamal, Youness Jabbour, Touzani Alae, Tariq Karmouni, Kadir El Khader, Abdelatif Koutani, Ahmed Ibn Attiya Andaloussi
Open Journal of Urology (OJU) , 2018, DOI: 10.4236/oju.2018.812037
Abstract: Cystitis glandularis or glandular metaplasia of the urinary bladder, is a benignreactive metaplasia of the urothelium, which occurs in the context of chronic irritation, in less than 2% of the general population. It is a condition in most casesasymptomatic, but also characterized by nonspecific symptoms and paraclinical findings, which is why this condition is underdiagnosed. Its evolution is mainly focused on the risk of malignant degeneration. This condition affects men much more commonly than women. Two forms of cystitis glandularis are recognized: typical and intestinal form. They differ in their histology, incidence, difficulty of diagnosis, and possible association with adenocarcinoma of the bladder. Diagnosis of certainty is histological by careful analysis of chips from bladder endoscopic resection. This rare pathology is managed by endoscopic bladder resection, with repeated cystoscopy as a monitoring tool. Extensive surgical is needed in severe or recurrent cases. We present here-in a case of a female patient having cystitis glandularis presenting with lower urinary tract symptoms. We review equally data reported in literature. To the best of our knowledge our case represents the fourth case of cystitis glandularis affecting a female patient reported in the English literature so far.
Bladder Pain Syndrome/Interstitial Cystitis Is Associated with Hyperthyroidism  [PDF]
Shiu-Dong Chung, Shih-Ping Liu, Ching-Chun Lin, Hsien-Chang Li, Herng-Ching Lin
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0072284
Abstract: Background Although the etiology of bladder pain syndrome/interstitial cystitis (BPS/IC) is still unclear, a common theme with BPS/IC patients is comorbid disorders which are related to the autonomic nervous system that connects the nervous system to end-organs. Nevertheless, no study to date has reported the association between hyperthyroidism and BPS/IC. In this study, we examined the association of IC/BPS with having previously been diagnosed with hyperthyroidism in Taiwan. Design Data in this study were retrieved from the Longitudinal Health Insurance Database. Our study consisted of 736 female cases with BPS/IC and 2208 randomly selected female controls. We performed a conditional logistic regression to calculate the odds ratio (OR) for having previously been diagnosed with hyperthyroidism between cases and controls. Results Of the 2944 sampled subjects, there was a significant difference in the prevalence of prior hyperthyroidism between cases and controls (3.3% vs. 1.5%, p<0.001). The conditional logistic regression analysis revealed that compared to controls, the OR for prior hyperthyroidism among cases was 2.16 (95% confidence interval (CI): 1.27~3.66). Furthermore, the OR for prior hyperthyroidism among cases was 2.01 (95% CI: 1.15~3.53) compared to controls after adjusting for diabetes, coronary heart disease, obesity, hyperlipidemia, chronic pelvic pain, irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, depression, panic disorder, migraines, sicca syndrome, allergies, endometriosis, and asthma. Conclusions Our study results indicated an association between hyperthyroidism and BPS/IC. We suggest that clinicians treating female subjects with hyperthyroidism be alert to urinary complaints in this population.
New Aspects in the Differential Diagnosis and Therapy of Bladder Pain Syndrome/Interstitial Cystitis  [PDF]
Jochen Neuhaus,Thilo Schwalenberg,Lars-Christian Horn,Henry Alexander,Jens-Uwe Stolzenburg
Advances in Urology , 2011, DOI: 10.1155/2011/639479
Abstract: Diagnosis of bladder pain syndrome/interstitial cystitis (BPS/IC) is presently based on mainly clinical symptoms. BPS/IC can be considered as a worst-case scenario of bladder overactivity of unknown origin, including bladder pain. Usually, patients are partially or completely resistant to anticholinergic therapy, and therapeutical options are especially restricted in case of BPS/IC. Therefore, early detection of patients prone to develop BPS/IC symptoms is essential for successful therapy. We propose extended diagnostics including molecular markers. Differential diagnosis should be based on three diagnostical “columns”: (i) clinical diagnostics, (ii) histopathology, and (iii) molecular diagnostics. Analysis of molecular alterations of receptor expression in detrusor smooth muscle cells and urothelial integrity is necessary to develop patient-tailored therapeutical concepts. Although more research is needed to elucidate the pathomechanisms involved, extended BPS/IC diagnostics could already be integrated into routine patient care, allowing evidence-based pharmacotherapy of patients with idiopathic bladder overactivity and BPS/IC. 1. Introduction There is an ongoing lively discussion about the diagnosis of interstitial cystitis (IC). Diagnosis mainly relies on clinical symptoms, since it has been shown that the more restrictive definition of the National Institute of Diabetes, Digestive, and Kidney Diseases (NIDDK) [1] failed to detect about 60% of the clinically significant IC patients [2]. Recently, IC has been redefined by the European Society for the Study of Interstitial Cystitis (ESSIC), which felt that bladder pain or discomfort to be most important criterion for differential diagnosis and inaugurated the term bladder pain syndrome/interstitial cystitis (BPS/IC) [3]. However, a number of alterations within the bladder wall, regarding detrusor smooth muscle cells [4–7], suburothelial myofibroblasts [8–10], innervation [11–14], urothelial function and integrity [15–19], and cytokine expression [20, 21], have been described, implying that pain symptoms develop relatively late in the cause of the disease. We hypothesize that initial urothelial impairment (unknown origin) initiates a pathophysiological cascade leading in long-term to the development of BPS/IC, and that severe pain symptoms are only present in late phase, that is, full blown clinical picture (Figure 1). Figure 1: Hypothetical course of BPS/IC development. While urgency develops in early “manifestation” phase, pain symptoms become evident only in late “end” phase, defining full-blown
Dabigatran Induced Hemorrhagic Cystitis in a Patient with Painful Bladder Syndrome  [PDF]
Helen Otteno,Erica Smith,R. Keith Huffaker
Case Reports in Urology , 2014, DOI: 10.1155/2014/871481
Abstract: An 82-year-old female presented with longstanding history of both painful bladder syndrome and atrial fibrillation. She underwent hydrodistension remarkable for hematuria without temporary discontinuation of Dabigatran. Subsequently, patient was admitted to the hospital secondary to anemia and hemorrhagic cystitis. 1. Introduction Dabigatran (Pradaxa) is a direct thrombin inhibitor which is used as an anticoagulant [1]. The recommended monitoring parameters for Dabigatran are less stringent than those for warfarin [2, 3]. Patients undergoing minor surgical procedures at minimal risk of bleeding may remain on Dabigatran. Dabigatran has not been previously associated with hemorrhagic cystitis. 2. Case An 82-year-old female with painful bladder syndrome presented with worsening symptoms of pelvic pain, dysuria, frequency, and urgency. Her past medical history was significant for atrial fibrillation, cerebrovascular accident, arthritis, and hypothyroidism. Patient’s past history was significant for a prior hydrodistension resulting in resolution of her symptoms for a few months. She underwent a CT abdomen and pelvis with/without contrast which revealed a diffuse thickening of the urinary bladder wall and no focal renal lesion or hydronephrosis. After an in-office cystourethroscopy, which was significant for hypervascularity and decreased capacity, she underwent four bladder instillations, with a mixture of marcaine, heparin, and saline, without relief of her symptoms. After each instillation, patient complained of small volume gross hematuria. Hydrodistension of her bladder was scheduled. However, at the time of her scheduled hydrodistension, the bladder was noted to be filled with a large blood clot. Bladder washings and biopsy were obtained at this time and the hydrodistension was not completed. No focus of bleeding could be identified. Visualization was markedly diminished. Clinical followup was planned for 2 days later. The pathology from the washings and biopsy revealed bladder mucosa with chronic inflammation, negative for malignancy. The patient subsequently was admitted to the hospital secondary to acute anemia, with a hematocrit (Hct) of 19.1% and a hemoglobin (Hgb) of 6.7?g/dL. She underwent transfusion with 4 units of PRBC, 5 units of frozen plasma, and 1 unit of platelets. An intravenous pyelogram revealed an intact bladder. Continuous bladder irrigation was performed. Significant laboratory results included PTT-SSH of 26.3 (11.1–13.5) seconds, PT of 2.3 (9.7–12.9) seconds, and PTT of 123.0 (24–34) seconds. Dabigatran was discontinued and
Squamous Cell Carcinoma of the Bladder Mimicking Interstitial Cystitis and Voiding Dysfunction  [PDF]
Colton Prudnick,Chad Morley,Robert Shapiro,Stanley Zaslau
Case Reports in Urology , 2013, DOI: 10.1155/2013/924918
Abstract: Squamous cell carcinoma (SCC) of the bladder is a relatively uncommon cause of bladder cancer accounting for <5% of bladder tumors in the western countries. SCC has a slight male predominance and tends to occur in the seventh decade of life. The main presenting symptom of SCC is hematuria, and development of this tumor in the western world is associated most closely with chronic indwelling catheters and spinal cord injuries. A 39-year-old Caucasian female presented with bladder and lower abdominal pain, urinary frequency, and nocturia which was originally believed to be interstitial cystitis (IC) but was later diagnosed as SCC of the bladder. Presentation of SCC without hematuria is an uncommon presentation, but the absence of this symptom should not lead a practitioner to exclude the diagnosis of SCC. This case is being reported in an attempt to explain the delay and difficulty of diagnosis. Background on the risk factors for SCC of the bladder and the typical presenting symptoms of bladder SCC and IC are also reviewed. 1. Introduction In western regions, primary SCC of the bladder is uncommon with an incidence of 1.2–4.5% of all vesical tumors [1–6]. There is a slightly greater male-to-female predominance ranging from 1.25?:?1 to 1.8?:?1 for the disease, and it occurs most frequently in the seventh decade of life [6]. Several risk factors for squamous cell carcinoma of the bladder include cigarette smoking, chronic recurrent urinary tract infections (UTIs), schistosomiasis secondary to Schistosoma haematobium infection, urinary tract calculi [6–9], clean intermittent self-catheterization [10–12], long-term catheterization, and a neurogenic bladder in spinal cord injured patients [7–9]. In contrast to bladder SCC, IC sufferers tend to be female and predominantly middle-aged [13]. Typically, presenting symptoms consist of subacute development of pain on bladder filling, urinary frequency unrelieved at night, urgency, and frequency of micturition [13, 14]. Over time, patients will complain of varying degrees of symptoms without total relief at any time despite antibiotic treatment. Urine cultures are negative and some urethral/vaginal tenderness may be the only physical exam finding [13]. When present in male patients, the most common symptoms are analogous to those in females. These include suprapubic pain, urinary frequency, and dysuria [15]. 2. Case Presentation The patient was a 39-year-old white female who had a 3-year history of bladder and lower abdominal pain. Additional symptoms were urinary frequency, nocturia, a weak force of stream, and
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