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Chang KM, Lee MH, Lin HH, Wu SL, Wu HC. Will cesarean section increase the risk of interstitial cystitis/painful bladder syndrome? Neurourol Urodyn 2018; 37:2638-2644. [PMID: 29717503 DOI: 10.1002/nau.23704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/04/2018] [Indexed: 11/10/2022]
Abstract
AIMS A high number of patients with interstitial cystitis/painful bladder syndrome (IC/PBS) have a history of pelvic surgeries, and cesarean section is one of the most common pelvic surgeries in women. This study aimed to investigate if cesarean section increases the risk of IC/PBS. METHODS Women who exclusively gave birth through cesarean section or vaginal delivery were identified from a nationwide database between 2002 and 2013. All were followed up during the study period to detect the event of IC/PBS. The IC/PBS hazard ratio (HR) in the cesarean cohort was compared with the vaginal delivery cohort with and without matching for confounding factors. RESULTS The unmatched group included 22 158 cesarean deliveries and 40 214 vaginal deliveries. The IC/PBS HR in the cesarean cohort compared with that in the vaginal delivery cohort was 1.370 (95% confidence interval [CI], 0.903-2.079; P = 0.139). In the matched group, 8368 women were matched in each cesarean and vaginal delivery cohort using propensity scores for age and comorbidities. The IC/PBS HR was 0.725 (95%CI, 0.358-1.471; P = 0.373). Both HRs in these two groups were not significantly different. The incidence density of IC/PBS in delivered women, non-delivery women, and the general female population were not significantly different either (0.310, 0.255, and 0.292 per 1000 person-years, respectively; P = 0.549). CONCLUSIONS The risk of IC/PBS was not different between cesarean and vaginal delivery after controlling the confounding factors in this cohort study. Cesarean section has no causal effect on IC/BPS. Furthermore, delivery was not a risk factor for IC/PBS.
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Affiliation(s)
- Kun-Min Chang
- Department of Obstetrics and Gynecology, Feng Yuan Hospital, Ministry of Health and Welfare, Taichung, Taiwan, Republic of China.,Department of Management Information Systems, Central Taiwan University of Science and Technology, Taichung, Taiwan, Republic of China
| | - Ming-Huei Lee
- Department of Management Information Systems, Central Taiwan University of Science and Technology, Taichung, Taiwan, Republic of China.,Department of Urology, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan, Republic of China.,Department of Urology, Feng Yuan Hospital, Ministry of Health and Welfare, Taichung, Taiwan, Republic of China
| | - Hsuan-Hung Lin
- Department of Management Information Systems, Central Taiwan University of Science and Technology, Taichung, Taiwan, Republic of China
| | - Shang-Liang Wu
- School of Medicine, Griffith University, Gold Coast, Australia
| | - Huei-Ching Wu
- Department of Urology, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan, Republic of China
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Lee MH, Chang KM, Wu SL, Lin HH, Lin HY, Wu HC. A cohort study of interstitial cystitis/bladder pain syndrome and hysterectomy. Int Urogynecol J 2016; 27:1401-7. [PMID: 26942595 DOI: 10.1007/s00192-016-2983-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 02/16/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Symptoms of interstitial cystitis/bladder pain syndrome (IC/BPS) are often confused with uterine conditions. Gynecologists may therefore recommend hysterectomy which was inappropriate for these patients. This study investigated whether IC/BPS increases the risk of hysterectomy in a large nationwide retrospective cohort study. METHODS From the Longitudinal Health Insurance Database 2010 (LHID2010) in Taiwan, we identified women diagnosed with IC/BPS between 2002 and 2013. Those with a history of hysterectomy before IC/BPS diagnosis were excluded. All women were stratified into three subgroups (younger, middle, older age) based on the propensity scores of 15 confounding factors, including age and comorbidities. All were followed until the end of 2013 to detect the event of hysterectomy. The hazard ratio (HR) of hysterectomy in the IC/BPS cohort was compared with the non-IC/BPS cohort among the three subgroups by Cox regression after adjusting for confounding factors. RESULTS In addition to the representative middle age, subgroup 2 had similar rates of comorbidities as the general population. The study was both externally and internally valid. The risk of hysterectomy in the IC/BPS cohort (n = 536) was significantly higher than in the non-IC/BPS cohort (n = 103846) in subgroup 2 (HR = 1.701, 95 % CI 1.056-2.740). The mean time to hysterectomy after diagnosis of IC/BPS was 2.97 years. CONCLUSIONS In this nationwide study, we found that IC/BPS has a causal impact on hysterectomy in the middle-age subgroup in LHID 2010. The possibility of a woman having IC/BPS should be evaluated prior to hysterectomy to avoid inappropriate surgery.
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Affiliation(s)
- Ming-Huei Lee
- Department of Urology, Feng Yuan Hospital, Ministry of Health and Welfare, Taichung, Taiwan, Republic of China.,Central Taiwan University of Science and Technology, Taichung, Taiwan, Republic of China
| | - Kun-Min Chang
- Central Taiwan University of Science and Technology, Taichung, Taiwan, Republic of China. .,Department of Obstetrics and Gynecology, Feng Yuan Hospital, Ministry of Health and Welfare, No.100, An-Kan Rd. Fengyuan Dist., Taichung City, 42055, Taiwan, Republic of China.
| | - Shang-Liang Wu
- School of Medicine, Griffith University, Gold Coast, Australia
| | - Hsuan-Hung Lin
- Central Taiwan University of Science and Technology, Taichung, Taiwan, Republic of China
| | - Hsiu-Ying Lin
- Department of anaesthesiology, Feng Yuan Hospital, Ministry of Health and Welfare, Taichung, Taiwan, Republic of China
| | - Huei-Ching Wu
- Department of Urology, Feng Yuan Hospital, Ministry of Health and Welfare, Taichung, Taiwan, Republic of China.,Central Taiwan University of Science and Technology, Taichung, Taiwan, Republic of China
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Abstract
Current management of bladder pain syndrome (BPS) was evaluated through a prospective electronic questionnaire posted on three patient support groups and sent to all members on the British Society of Urogynaecology (BSUG) database. Methods of diagnosis and treatment were assessed. 133 patients and 69 clinicians participated in the survey. Patients reported their main symptom to be pain when their bladder was full in 80% (n = 107) and the most bothersome symptom was pelvic pain (22%, n = 29). 93% (n = 64) of clinicians made their diagnosis by history and cystoscopy. 78% (n = 54) of clinicians treated patients with amitriptyline and 75% (n = 52) by dietary modification while 77% (n = 102) of patients reported using simple analgesia, 74% (n = 98) dietary modification and 62% (n = 83) low-dose long-term antibiotics. There is wide variation in diagnostic methods and treatments of BPS used by clinicians and experienced by patients with no obvious consensus. National guidance is needed to help standardise care.
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Affiliation(s)
- S A Tirlapur
- a Women's Health Research Unit, Queen Mary, University of London , London , UK
| | - K S Khan
- a Women's Health Research Unit, Queen Mary, University of London , London , UK.,b Barts Health NHS Trust, The Royal London Hospital , London , UK
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Brooks L, Hadi J, Amber KT, Weiner M, La Riche CL, Ference T. Assessing the prevalence of autoimmune, endocrine, gynecologic, and psychiatric comorbidities in an ethnically diverse cohort of female fibromyalgia patients: does the time from hysterectomy provide a clue? J Pain Res 2015; 8:561-9. [PMID: 26316807 PMCID: PMC4548754 DOI: 10.2147/jpr.s86573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background This retrospective chart review investigated differences in the prevalence of medical comorbidity between women with fibromyalgia (FM) (n=219) and a control group women with chronic pain (CP) without FM (n=116). The specific aims were to compare the prevalence of autoimmune, psychiatric, endocrine, gynecologic pathology, the relationship between timing of gynecologic surgery, and pain onset. We additionally sought to compare the number of comorbidities in an ethnically diverse cohort. Methods This was a retrospective chart review of patients seen in FM or CP clinics at an academic medical center in 2009–2010. Results Logistic regression modeling found that gynecologic, endocrine, and autoimmune diagnoses were independently associated with a diagnosis of FM. Detailed analyses showed that thyroid disease (P<0.01) and gynecologic surgery (P<0.05) were significantly more common in FM. Women with FM were more likely to have multiple autoimmune, endocrine, gynecologic, or psychiatric pathologies. A relationship was observed between the timing of gynecologic surgery and pain onset in FM, with more surgeries observed in the years just prior to pain onset or in the year after pain onset. A similar pattern was not found in the control group. Conclusion This study demonstrates that autoimmune, endocrine, and gynecologic pathologies occur more commonly in women with FM than in those with CP, which is consistent with findings in less ethnically diverse samples. Moreover, a relationship was found between timing of pain onset and gynecologic surgery. A larger prospective study of the relationship between gynecologic surgery and pain onset in FM is warranted.
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Affiliation(s)
- Larry Brooks
- Department of Rehabilitation Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joseph Hadi
- Anesco Interventional Pain Institute, Margate, FL, USA
| | - Kyle T Amber
- Department of Rehabilitation Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Christopher L La Riche
- Department of Psychiatry and Behavioral Health, Florida International University Wertheim College of Medicine, University Park, FL, USA
| | - Tamar Ference
- Department of Rehabilitation Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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Warren JW, Clauw DJ, Wesselmann U, Howard FM, Gallicchio L, Morozov V. Functional somatic syndromes as risk factors for hysterectomy in early bladder pain syndrome/interstitial cystitis. J Psychosom Res 2014; 77:363-7. [PMID: 25258358 DOI: 10.1016/j.jpsychores.2014.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 09/02/2014] [Accepted: 09/05/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVE We tested the hypothesis that functional somatic syndromes (FSSs) are risk factors for hysterectomy in early bladder pain syndrome/interstitial cystitis (BPS/IC). METHODS In 312 women with incident BPS/IC, we diagnosed seven pre-BPS/IC syndromes: chronic pelvic pain (CPP), fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome (IBS), sicca syndrome, migraine, and panic disorder. Each was defined as present before 12 months (existing syndrome) or onset within 12 months (new syndrome) prior to BPS/IC onset. Retrospectively, we sought associations between prior hysterectomy and existing FSSs. Prospectively, we studied associations of existing and new syndromes with subsequent hysterectomy. Logistic regression analyses adjusted for age, race, menopause and education. RESULTS The retrospective study showed prior hysterectomy (N=63) to be associated with existing CPP and the presence of multiple existing FSSs. The prospective study revealed that 30/249 women with a uterus at baseline (12%) underwent hysterectomy in early BPS/IC. This procedure was associated with new CPP (OR 6.0; CI 2.0, 18.2), new IBS (OR 5.4; CI 1.3, 22.3), and ≥3 existing FSSs (OR 3.9; CI 1.1, 13.9). CONCLUSION Accounting for CPP and IBS, the presence of multiple FSSs (most without pelvic pain) was a separate, independent risk factor for hysterectomy in early BPS/IC. This suggests that patient features in addition to abdominopelvic abnormalities led to this procedure. Until other populations are assessed, a prudent approach to patients who are contemplating hysterectomy (and possibly other surgeries) for pain and who have IBS or numerous FSSs is first to try alternative therapies including treatment of the FSSs.
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Affiliation(s)
- John W Warren
- Department of Medicine, University of Maryland School of Medicine, United States; Department of Epidemiology and Public Health, University of Maryland School of Medicine, United States.
| | - Daniel J Clauw
- Department of Anesthesiology, University of Michigan School of Medicine, United States; Department of Medicine, University of Michigan School of Medicine, United States
| | - Ursula Wesselmann
- Department of Anesthesiology, University of Alabama at Birmingham School of Medicine, United States; Department of Neurology, University of Alabama at Birmingham School of Medicine, United States
| | - Fred M Howard
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, United States
| | - Lisa Gallicchio
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, United States
| | - Vadim Morozov
- Department of Obstetrics and Gynecology, University of Maryland School of Medicine, United States
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Charrua A, Pinto R, Taylor A, Canelas A, Ribeiro-da-Silva A, Cruz CD, Birder LA, Cruz F. Can the adrenergic system be implicated in the pathophysiology of bladder pain syndrome/interstitial cystitis? A clinical and experimental study. Neurourol Urodyn 2013; 34:489-96. [PMID: 24375689 DOI: 10.1002/nau.22542] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 11/29/2013] [Indexed: 12/20/2022]
Abstract
AIMS To evaluate sympathetic system activity in bladder pain syndrome/interstitial cystitis (BPS/IC) patients and to investigate if chronic adrenergic stimulation in intact rats induces BPS/IC-like bladder modifications. METHODS Clinical study--In BPS/IC patients and aged and body mass index matched volunteers TILT test was undertaken and catecholamines were measured in plasma and 24 hr urine samples. Experimental study--Phenylephrine was injected subcutaneously (14 days) to female Wistar rats. Pain behavior, spinal Fos expression, urinary spotting, number of fecal pellets expelled, frequency of reflex bladder contractions, and urothelial height were analyzed. Urothelium permeability was investigated by trypan blue staining. Immunoreactivity against caspase 3 and bax were studied in the urothelium and against alpha-1-adrenoreceptor and TRPV1 in suburothelial nerves. Mast cell number was determined in the sub-urothelium. In rats with lipopolysaccharide-induced cystitis, urinary catecholamines, and Vesicular Monoamine Transporter 2 (VMAT2) expression in bladder nerves were analyzed. RESULTS The TILT test showed an increase of sympathetic activity. Noradrenaline levels in blood at resting conditions and in 24-hr urine samples were higher in BPS/IC patients. Phenylephrine administration increased visceral pain, spinal Fos expression, bladder reflex activity, urinary spotting and the number of expelled fecal pellets. The mucosa showed urothelial thinning and increased immunoreactivity for caspase 3 and bax. Trypan blue staining was only observed in phenylephrine treated animals. Suburothelial nerves co-expressed alpha1 and TRPV1. Mastocytosis was present in the suburothelium. Cystitis increased sympathetic nerve density and urinary noradrenaline levels. CONCLUSIONS Excessive adrenergic stimulation of the bladder may contribute to the pathophysiological mechanisms of BPS/IC.
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Affiliation(s)
- Ana Charrua
- Department of Experimental Biology, Faculty of Medicine, University of Porto, Porto, Portugal.,IBMC - Instituto de Biologia Molecular e Celular, University of Porto, Porto, Portugal.,Department of Renal, Urologic and Infectious Disease, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Urology, S. João Hospital, Porto, Portugal
| | - Rui Pinto
- IBMC - Instituto de Biologia Molecular e Celular, University of Porto, Porto, Portugal.,Department of Renal, Urologic and Infectious Disease, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Urology, S. João Hospital, Porto, Portugal
| | - Anna Taylor
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada
| | - André Canelas
- Department of Experimental Biology, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Célia D Cruz
- Department of Experimental Biology, Faculty of Medicine, University of Porto, Porto, Portugal.,IBMC - Instituto de Biologia Molecular e Celular, University of Porto, Porto, Portugal
| | - Lori Ann Birder
- Departments of Medicine and Pharmacology-Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Francisco Cruz
- IBMC - Instituto de Biologia Molecular e Celular, University of Porto, Porto, Portugal.,Department of Renal, Urologic and Infectious Disease, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Urology, S. João Hospital, Porto, Portugal
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