Clinical and histological findings in bladder pain syndrome/interstitial cystitis: The implication of time of symptoms

Objective:

To find out whether a correlation exists between denudation of urothelium and time of symptom onset in patients with bladder pain syndrome/interstitial cystitis (BPS/IC), and to search for a correlation between the impact of symptoms.

Patients and methods:

Fifty-seven consecutive patients underwent cystoscopy under anaesthesia to classify those cases suspected of being affected with BPS/IC. The time elapsed between onset of symptoms and diagnosis at the time of bladder biopsy was also defined as BPS/IC duration. Bladder biopsies were taken including detrusor muscle, three deep cold biopsies of posterior, anterior and lateral bladder wall.

Results:

Statistical analysis showed significant correlation between BPS/IC duration and the presence of Hunner’s lesions ( P<0.023). Hunner’s lesion with cystoscopy and histological evidence of urothelial denudation with bladder biopsy appear to be related to BPS/IC duration. Thus an early diagnosis allows an appropriate therapeutic approach to be started to prevent a more severe evolution of this multifaceted painful syndrome.

Conclusions:

Our study shows a correlation between the time of symptom onset and evidence of urothelial denudation and with detrusor mast cell count in the whole group of patients. BPS/IC duration did not seem to correlate with the severity of symptoms, but rather with the presence of associated diseases.

Level of evidence:

Not applicable for this multicentre audit.

A pilot study of clinical results of Odyliresin (Iresine celosia) in symptomatic benign prostatic hyperplasia

Aim:

The aim of this pilot clinical trial was to determine if Odyliresin ( Iresine celosia), a cytochrome-flavoprotein with a powerful anti-oxidant action on cells, has a therapeutic effect on benign prostatic hyperplasia-related lower urinary tract symptoms, reducing symptoms and prostate volume, improving the patient’s quality of life and eventually limiting the number of patients who require surgery or endoscopy after medical treatment.

Methods:

Thirty patients with benign prostatic hyperplasia-related lower urinary tract symptoms were recruited and followed up. Primary outcomes were assessed using International Prostate Symptom Score symptom questionnaires, quality of life score, examination, prostate-specific antigen, transrectal ultrasound, uroflowmetry with post-void residual volume. Once recruited, patients were assigned for treatment: alpha-antagonist (alfuzosin 10 mg)+Odyliresin ( Iresine celosia) 2 ml, 20 drops once daily.

Results:

The results for quantitative variables were expressed as mean values and standard deviation as they were all normally distributed (Shapiro–Wilk test). The study included 30 patients with an average age of 68 years (range 56–80 years). The statistical analysis of data reports significant improvement of mean values of maximum urinary flow rate (+1.2, p=0.050), average flow rate (+0.47, p>0.002), International Prostate Symptom Score (–4.8, p=0.000), quality of life (–1.4, p=0.000), total prostatic volume (–1.7, p=0.000), prostatic adenoma (–6.9, p=0.000) and post-void residual volume (–17.8, p>0.004) between baseline and 12 months after treatment. No patient had acute urinary retention during treatment or need for benign prostatic hyperplasia-related surgery at the end of the 12-month treatment.

Conclusions:

All patients with benign prostatic hyperplasia-related lower urinary tract symptoms received both alphalitic and Odyliresin treatment. Clinical parameters and uroflowmetry parameters significantly improved, adenoma volume and post-void residual volume were significantly reduced at 12 months. This is the first clinical experience with Iresine celosia, a phytotherapeutic agent with no scientifically proven clinical efficacy so far in benign prostatic hyperplasia.

Oral D-mannose in recurrent urinary tract infections in women: a pilot study

Background:

In recurrent urinary tract infections (UTIs) usual prophylactic antibiotic regimes do not change the long-term risk of recurrence. Our aim was to evaluate the efficacy of D-mannose in the treatment and prophylaxis of recurrent UTIs.

Methods:

In this randomized cross-over trial female patients were eligible for the study if they had an acute symptomatic UTI and three or more recurrent UTIs during the preceding 12 months. Suitable patients were randomly assigned to antibiotic treatment with trimethoprim/sulfamethoxazole or to a regimen of oral D-mannose 1 g 3 times a day, every 8 hours for 2 weeks, and subsequently 1 g twice a day for 22 weeks. They received the other intervention in the second phase of the study, with no further antibiotic prophylaxis. The primary endpoint was evaluation of the elapsed time to recurrence; secondary endpoints were evaluation of bladder pain (VASp) and urinary urgency (VASu).

Results:

The results for quantitative variables were expressed as mean values and SD as they were all normally distributed (Shapiro–Wilk test). In total, 60 patients aged between 22 and 54 years (mean 42 years) were included. Mean time to UTI recurrence was 52.7 days with antibiotic treatment, and 200 days with oral D-mannose ( p < 0.0001).

Conclusions:

Mean VASp, VASu score, and average numbers of 24-hour voidings decreased significantly. D-mannose appeared to be a safe and effective treatment for recurrent UTIs in adult women. A significant difference was observed in the proportion of women remaining infection free versus antibiotic treatment.