This pain drives me crazy:Psychiatric symptoms in women with interstitial cystitis/bladder pain syndrome

BACKGROUND Interstitial cystitis/bladder pain syndrome(IC/BPS)is an at least 6-mo noninfectious bladder inflammation of unknown origin characterized by chronic suprapubic,abdominal,and/or pelvic pain.Although the term cystitis suggests an inflammatory or infectious origin,no definite cause has been identified.It occurs in both sexes,but women are twice as much affected.AIM To systematically review evidence of psychiatric/psychological changes in persons with IC/BPS.METHODS Hypothesizing that particular psychological characteristics could underpin IC/BPS,we investigated in three databases the presence of psychiatric symptoms and/or disorders and/or psychological characteristics in patients with IC/BPS using the following strategy:("interstitial cystitis"OR"bladder pain syndrome")AND("mood disorder"OR depressive OR antidepressant OR depression OR depressed OR hyperthymic OR mania OR manic OR rapid cyclasterisk OR dysthymiasterisk OR dysphoriasterisk).RESULTS On September 27,2023,the PubMed search produced 223 articles,CINAHL 62,and the combined PsycLIT/PsycARTICLES/PsycINFO/Psychology and Behavioral Sciences Collection search 36.Search on ClinicalTrials.gov produced 14 studies,of which none had available data.Eligible were peer-reviewed articles reporting psychiatric/psychological symptoms in patients with IC/BPS,i.e.63 articles spanning from 2000 to October 2023.These studies identified depression and anxiety problems in the IC/BPS population,along with sleep problems and the tendency to catastrophizing.CONCLUSION Psychotherapies targeting catastrophizing and life stress emotional awareness and expression reduced perceived pain in women with IC/BPS.Such concepts should be considered when implementing treatments aimed at reducing IC/BPS-related pain.

Addressing quality of life in the patient with interstitial cystitis/bladder pain syndrome

Interstitial cystitis/bladder pain syndrome(IC/BPS)is a debilitating,chronic condition characterized by chronic pelvic pain,urinary urgency,and frequency and is well-known to be associated with a decrease in work productivity,emotional changes,sleep,sexual dysfunction,and mobility.Many metrics of quality of life(QoL)in this patient population have been developed;however,a unified,standardized approach to QoL in these patients has not been determined.The effects of IC/BPS and co-morbid conditions on QoL are described using current validated metrics.Next,data regarding successful treatment of IC/BPS in terms of QoL improvement are reviewed.While QoL is the single most important clinical measure of success in the treatment of patients suffering from IC/BPS,addressing QoL in this patient population remains a significant challenge,as its effects on QoL are highly variable and unable to be differentiated from the effects of comorbid conditions on QoL,including depression,poor sleep,and inability to work.Future studies will need to address treatment efficacy on the basis of IC/BPS specific QoL metrics,and multi-modal assessment and therapy to address comorbid disease will also play an important role in the future to ensure comprehensive management of these patients.

Carboxytherapy and Platelet Rich Plasma： A New Therapy for Trigonitis, Abacterial and Interstitial Cystitis

Cystitis often appears even in absence of bacteria colonization. Trigonitis and interstitial inflammation are the most common morphological features of abacterial cystitis in young and post menopausal women. Arterial obstructive disease and bladder ischemia might play an important role in bladder dysfunction. Activated inflammatory cells produce ROS （radicals of oxygen）, NF kB seems involved in ROS synthesis. Clinical studies have indicated that high CO2 levels can impact upon peripheral tissue, reducing ischaemia, responsible of recurrent inflammation and consequently reducing oxydative phenomena. PRP （platelet-rich plasma） is a volume of fractionated plasma from the patient＇s own blood that contains platelet concentrate rich of alpha granules. PRP interacts tissue repair mechanisms by placing supra-physiological concentrations of autologous platelets at the site of tissue damage. This study proposes a single PRP transvaginal injection followed by 10 weekly applications of carboxytherapy, using subcutaneous injections of sterile CO2 gas. We have selected 6 Women （50-75 years）, affected by recurrent abacterial cystitis with Pain and urge incontinence. All patients showed a subjective sensible reduction of symptoms. After 2 months all patients have neither inflammatory symptoms nor endoscopic evidence of trigonitis. Preliminary qualitative results could encourage the use of carboxytherapy and PRP in treatment of abacterial and interstitial cystitis.

Expressions of Uroplakin gene family in interstitial cystitis

Objective To detect gene expressions of Uroplakin ( UP) family in interstitial cystitis ( IC) . Methods Gene expression of UP Ia,Ib,II,III,and III-c34 was quantitatively measured in bladder biopsy samples from patients with IC ( n = 29) and control subjects ( n = 16)

Intravesical instillation of platelet-rich plasma for treatment of interstitial cystitis/bladder pain syndrome:A pilot study

Objective:The aim of this study was to evaluate the feasibility of intravesical instillation of platelet-rich plasma(PRP)to treat interstitial cystitis/bladder pain syndrome(IC/BPS).Materials and methods:Twenty PRP samples were tested in vitro for stability after exposure to urine samples with different pH.A pilot study involving 21 female patients with IC/BPS was conducted,and 6 weekly doses of autologous PRP(50 mL)were administered.Patients were followed up at the 2nd,4th,8th,and 12th weeks after terminating instillation.The primary endpoint was the visual analog scale(VAS)for pain,and the secondary endpoints included the IC symptom index,IC problem index of the O'Leary-Sant questionnaire and global response assessment,urine culture,and uroflowmetry.Success was defined as a reduction in VAS by 30%or more compared with basal level,and adverse events were recorded.Results:The mean±SD of VAS was significantly reduced compared with basal level(4.4±2.6 vs.8.8±1.1,respectively,p=0.001).Meanwhile,80%of cases were considered successful,with a 50.1%reduction in the mean score compared with the basal level.The mean±SD of IC symptom index and IC problem index significantly improved compared with the basal level.Global response assessment was markedly,moderately,and slightly improved in 2(10%),10(50%),and 5(25%)patients,respectively,and showed no change in 3(15%).Three patients had positive urine cultures at follow-up,but 1 withdrew after 2 sessions because of a lack of efficacy.Conclusions:Repeated intravesical instillation of PRP could be considered an effective and safe approach for treating IC/BPS.

Phloroglucinol Protects the Urinary Bladder Via Inhibition of Oxidative Stress and Inflammation in a Rat Model of Cyclophosphamide-induced Interstitial Cystitis

Background： Phloroglucinol plays an important role in oxidative stress and inflammatory responses. The effects of phloroglucinol have been proven in various disease models. The aim of the present study was to investigate the efficacy and possible mechanisms of phloroglucinol in the treatment of interstitial cystitis （IC）. Methods： Thirty-two female Sprague-Dawley （SD） rats were used in this study. IC was induced by intraperitoneal injection of cyclophosphamide （CYP）. Rats were randomly allocated to one of four groups （n = 8 per group）： A control group, which was injected with saline （75 mg/kg; i.p.） instead of CYP on days 1, 4, and 7; a chronic IC group, which was injected with CYP （75 mg/kg; i.p.） on days l, 4, and 7; a high-dose （30 mg/kg） phloroglucinol-treated group; and a low-dose （15 mg/kg） phloroglucinol-treated group. On day 8, the rats in each group underwent cystometrography （CMG）, and the bladders were examined for evidence of oxidative stress and inflammation. Statistical analysis was performed by analysis of variance （ANOVA） followed by least square difference multiple comparison po.s＇t-hoc test. Results： Histological evaluation showed that bladder inflammation in CYP-treated rats was suppressed by phloroglucinol. CMG revealed that the CYP treatment induced overactive bladder in rats that was reversed by phloroglucinol. Up-regulated tumor necrosis factor-or and interleukin-6 expression in the CYP-treated rats were also suppressed in the phloroglucinol treated rats. CYP treatment significantly increased myeloperoxidase activity as well as the decreased activities ofcatalase of the bladder, which was reversed by treatment with phloroglucinol. Conclusions： The application of phloroglucinol suppressed oxidative stress, inflammation, and overactivity in the bladder. This may provide a new treatment strategy for IC.

Risk factors for interstitial cystitis/painful bladder syndrome in patients with lower urinary tract symptoms： a Chinese multi-center study

Background Despite 100 years of research, the continued absence of well-established risk factors impedes the diagnosis and treatment of interstitial cystitis/painful bladder syndrome （IC/PBS）. We aimed to identify risk factors in patients with lower urinary tract symptoms （LUTS） without urinary tract infection or benign prostate hyperplasia in China.Methods A total of 397 outpatients with LUTS presenting for care to urology clinics in several hospitals throughout China were surveyed using a standardized questionnaire and validated outcome measures. The definitions for painful bladder syndrome based on the O‘Leary-Sant interstitial cystitis symptom and problem indices were used. The prevalence of possible risk factors was analyzed using the Fisher＇s exact test and Pearson chi-square test, and multivariate predictive models were developed using binary Logistic regression methods.Results Of those multi-centre patients surveyed, including 174 women and 223 men, 41% （162/397） met criteria for painful bladder syndrome. There was a significant difference between women and men （55% （95/174） vs. 30% （67/223）,P 〈0.001）. Women with IC/PBS were more likely than those without IC/PBS to report a history of gynecological infections （odds ratio （OR）： 2.85; 95% confidence interval （CI）： 1.32-6.16, P=0.007）, intake of stimulatory foods （OR： 3.52; 95% CI：1.50-8.30; P=0.004）, irritable bowel （OR： 3.46; 95% CI： 1.22-9.80; P=0.014） and/or anorectal disease （OR： 2.68; 95% CI：1.12-6.40, P=0.023）. After adjusting for confounding factors, bladder pain was significantly associated with stimulatory foods （OR： 3.85; 95% CI： 1.58-9.36, P=0.003） and anorectal disease （OR： 2.76; 95% CI： 1.09-7.04, P=0.03） in women.Caffeine beverage intake （OR： 3.54; 95% CI： 1.54-8.12, P=0.003） was identified the only modifiable association noted in multivariate analysis of men.Conclusions We found that stimutatory foods, anorectal disease and caffeine beverages are potential risk factors for IC/PBS. Further studies are necessary to determine their role in the pathogenesis of this disorder.

Effects of Additional Glycine in Outpatients Being Treated for Urine Storage Disorders

Objectives: This study aimed to determine whether additional glycine can improve urine storage symptoms in outpatients. Methods: We recruited 50 outpatients (15 females, 35 males) with an Overactive Bladder Symptom Score (OABSS) of 3 or more. Participants being treated for urine storage disorders took additional glycine for 8 weeks at a dose of 3 g twice a day. Outcome measures included blood pressure, the International Prostate Symptom Score (IPSS), OABSS, Nocturia Quality of Life (N-QOL) score, urination frequency, sleep latency, time until the first void at night, bladder pain, improvement in urinary symptoms assessed with the Global Self-Assessment (GSA), and adverse events. Results: In the OABSS, the number of nighttime voids, urgency to urinate, urgent incontinence, and total score were improved. Improvements were also found in the IPSS total score for urine storage items, blood pressure, IPSS-QOL, time to first void, bladder pain, and GSA score, but no changes were seen in the frequency of urination at night, sleep latency or N-QOL score. No adverse events were recorded. Conclusion: Oral glycine improves objective and self-assessed urine storage symptoms, blood pressure, and bladder pain.

Efficacy of transcutaneous tibial nerve stimulation in the treatment of bladder pain syndrome

Background:This study aimed to demonstrate the effectiveness of transcutaneos tibial nerve stimulation(TTNS)in the treatment of bladder pain syndrome(BPS).Materials and methods:The data of 16 female patients,diagnosed with BPS in our clinic between 2019 and 2021 and had TTNS twice a week for 12 weeks,were retrospectively analyzed.Results:The mean age of the patients was 46.00±13.11 years,and the mean body mass index was 26.43±3.07 kg/m^(2).After the treatment,the median day time frequency of the patients decreased from 13.37(3.69)to 10.25(4.56)(p<0.001).Nocturia also decreased after treatment from 4.37(1.81)to 3.00(1.94)(p=0.001).The median voiding volume increased by 26.5 mL(p=0.001).The median of the patients'visual analog scale scores decreased after treatment(median of visual analog scale score changed from interquartile range 8[1]to 7[4])(p=0.001).In addition,the median interquartile range interstitial cystitis symptom index scores decreased from 17(4)to 15(10)(p=0.002).Conclusions:In this study it was demonstrated that TTNS is an alternative method that can be successfully applied before invasive methods in the treatment of BPS.