The Therapeutic Approach to Different forms of Cystitis: Impact on Public Health

Interstitial cystitis/bladder pain syndrome, recurrent urinary tract infections and other forms of cystitis signifi-cantly impact the quality of life of patients with chronic bladder disorders and impose a considerable economic burden on health systems. Effective management is essential to provide symptom relief and to reduce the negative impact of chronic bladder disorders. Identifying the appropriate pharmacological or non-pharmacological approach is essential, and there is a growing evidence base for the use of intravesical hyaluronic acid and chon-droitin sulfate in several bladder conditions, including recurrent urinary tract infections.

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Interstitial cystitis/bladder pain syndrome and recurrent urinary tract infection and the potential role of the urinary microbiome

Post Reproductive Health ◽

10.1177/2053369120936426 ◽

2020 ◽

Vol 26 (2) ◽

pp. 87-90

Author(s):

Alka Bhide ◽

Visha Tailor ◽

Vik Khullar

Keyword(s):

Urinary Tract ◽

Interstitial Cystitis ◽

Urinary Tract Infections ◽

Potential Role ◽

Pain Syndrome ◽

Bladder Pain Syndrome ◽

Bladder Pain ◽

Urinary Microbiome ◽

Tract Infections

Interstitial cystitis/bladder pain syndrome and recurrent urinary tract infections carry significant burden for those affected. As women enter the menopause, other factors may influence how these conditions manifest. The urinary microbiome has shown that the urine contains extensive numbers of bacteria. There is some evidence to suggest that it is altered depending on the menopausal state of the individual. It is possible that this alteration may go on to influence how the disease course of interstitial cystitis/bladder pain syndrome and recurrent urinary tract infections runs in the post-menopausal group. The review will explore these two conditions and the potential role of the urinary microbiome.

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Improvements in patients’ quality of life following treatment with intravesical hyaluronic acid (Cystistat 40 mg) for bladder pain syndrome and recurrent UTIs

Journal of Clinical Urology ◽

10.1177/2051415819899266 ◽

2020 ◽

Vol 13 (2) ◽

pp. 144-149

Author(s):

Thomas D Brophy ◽

Sue Fowler ◽

Louise Clarke ◽

Andy Thompson

Keyword(s):

Quality Of Life ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Pain Syndrome ◽

Bladder Pain Syndrome ◽

Health Questionnaire ◽

Bladder Pain ◽

King’S Health Questionnaire ◽

Tract Infections

Introduction: Intravesical hyaluronic acid (Cystistat) is indicated for a variety of chronic cystitis conditions including bladder pain syndrome, recurrent bacterial urinary tract infections and radiation or chemical cystitis. Previously published studies have predominantly assessed the outcome in terms of bladder symptoms (frequency/urgency/nocturia/pain) or in the case of recurrent bacterial urinary tract infection, by microbiological response. The aim of this study was to assess improvement in patients’ quality of life following treatment with intravesical Cystistat. Materials and methods: Patients’ referred for treatment with intravesical Cystistat for either bladder pain syndrome or recurrent bacterial urinary tract infection completed the King’s health questionnaire. Patients were treated with a 6-week course of Cystistat by one of two specialist urology nurses. If treatment was effective further instillations were given every 2–4 weeks for up to 6 months. King’s health questionnaire scores were repeated after 6 weeks and 6 months and were analysed. Results: Twenty patients (18 women, 2 men) were included: 8 bladder pain syndrome, 12 recurrent bacterial urinary tract infections. There were four treatment failures within 6 weeks, of whom three were being treated for recurrent bacterial urinary tract infections. Of the 16 patients who continued with treatment beyond 6 weeks, 12 have 6-month scores available. The average initial King’s health questionnaire score was 500.8 (534.1 for the recurrent bacterial urinary tract infection group, 450.8 for the bladder pain syndrome group). After six treatments average King’s health questionnaire scores improved to 426.3 (457.7 for recurrent bacterial urinary tract infections, 372.4 for bladder pain syndrome). After 6 months, average scores significantly improved to 278 overall (303.2 ( P<0.05) for the recurrent bacterial urinary tract infections group, 252.8 ( P>0.05) for the bladder pain syndrome group). Conclusion: Intravesical Cystistat should be considered in all patients with bladder pain syndrome and recurrent bacterial urinary tract infections. We have shown a significant, clinically important, improvement in patients’ quality of life in refractory bladder pain syndrome and recurrent bacterial urinary tract infections. In future Cystistat could be considered as an alternative to long-term low-dose antibiotic prophylaxis. Level of evidence: 4

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Bladder Pain: The Patient Perspective

Urologia Journal ◽

10.5301/uj.5000261 ◽

2017 ◽

Vol 84 (1_suppl) ◽

pp. 5-7 ◽

Cited By ~ 3

Author(s):

Jane M. Meijlink

Keyword(s):

Quality Of Life ◽

Chronic Pain ◽

Urinary Tract ◽

Patient Perspective ◽

Pain Syndrome ◽

Bladder Pain Syndrome ◽

Bladder Pain ◽

Practical Support ◽

Tract Infections

Patients with chronic pain, discomfort and other urinary symptoms related to bladder pain syndrome or urinary tract infections may experience severely diminished quality of life and psychological and social problems, including depression, anxiety, and a sense of helplessness and hopelessness. These patients require empathy, understanding and practical support to allow them to cope with their chronic bladder disorder.

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Urology

Urogynaecology ◽

10.1093/med/9780198829065.003.0005 ◽

2020 ◽

pp. 83-110

Author(s):

Helen Jefferis ◽

Natalia Price

Keyword(s):

Urinary Tract ◽

Pain Syndrome ◽

Bladder Pain Syndrome ◽

Mechanism Of Injury ◽

Bladder Pain ◽

Ureteric Stenting ◽

Investigation Methods ◽

Vesicovaginal Fistulae ◽

Injury And Repair ◽

Tract Infections

This chapter covers various issues to do with urology in women. It begins by listing different investigation methods and what conditions they are best prepared to show. It then goes through various urological problems that may be encountered, such as ureteric stenting, haematuria, urinary tract infections and non-bacterial cystitis, and bladder pain syndrome. Urethral conditions and injuries to the urinary tract are both covered, including mechanism of injury and repair. Catheters, vesicovaginal fistulae, and urinary diversion are also described and given techniques for management.

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Is Clinical Practice Aligned with the Latest Scientific Evidence on GAG Therapy?

Urologia Journal ◽

10.5301/uj.5000259 ◽

2017 ◽

Vol 84 (1_suppl) ◽

pp. 16-20 ◽

Cited By ~ 1

Author(s):

Dick A.W. Janssen

Keyword(s):

Urinary Tract ◽

Scientific Evidence ◽

Pain Syndrome ◽

Bladder Pain Syndrome ◽

Bladder Pain ◽

Radiation Cystitis ◽

Bladder Urothelium ◽

Bladder Diseases ◽

Tract Infections

The role of glycosaminoglycans (GAGs) as key components of the protective bladder barrier is well accepted. Replenishment of the GAG layer could restore the normal protective barrier function of the damaged bladder urothelium and re-establish normal permeability. A number of bladder diseases, including interstitial cystitis/ bladder pain syndrome, recurrent urinary tract infections, radiation cystitis, and other forms of cystitis may ben-efit from GAG therapy.

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D-MannosE to prevent Recurrent urinary tract InfecTions (MERIT): protocol for a randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2020-037128 ◽

2021 ◽

Vol 11 (1) ◽

pp. e037128

Author(s):

Marloes Franssen ◽

Johanna Cook ◽

Jared Robinson ◽

Nicola Williams ◽

Margaret Glogowska ◽

...

Keyword(s):

Quality Of Life ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Negative Impact ◽

Controlled Trial ◽

Pragmatic Trial ◽

Double Blind ◽

Recurrent Urinary Tract Infections ◽

Tract Infections

IntroductionRecurrent urinary tract infections (RUTIs) have a significant negative impact on quality of life and healthcare costs. To date, daily prophylactic antibiotics are the only treatment which have been shown to help prevent RUTIs. D-mannose is a type of sugar which is believed to inhibit bacterial adherence to uroepithelial cells, and is already being used by some women in an attempt to prevent RUTIs. There is currently insufficient rigorous evidence on which to base decisions about its use. The D-mannose to prevent recurrent urinary tract infections (MERIT) study will evaluate whether D-mannose is clinically and cost-effective in reducing frequency of infection and symptom burden for women presenting to UK primary care with RUTI.Methods and analysisMERIT will be a two-arm, individually randomised, double blind placebo controlled, pragmatic trial. Participants will be randomised to take D-mannose powder or placebo powder daily for 6 months. The primary outcome will be the number of medical attendances attributable to symptoms of RUTI. With 508 participants we will have 90% power to detect a 50% reduction in the chance of a further clinically suspected UTI, assuming 20% lost to follow-up. Secondary outcomes will include: number of days of moderately bad symptoms of UTI; time to next consultation; number of clinically suspected UTIs; number of microbiologically proven UTIs; number of antibiotic courses for UTI; quality of life and healthcare utilisation related to UTI. A within trial economic evaluation will be conducted to examine cost-effectiveness of D-mannose in comparison with placebo. A nested qualitative study will explore participants’ experiences and perceptions of recruitment to, and participation in a study requiring a daily treatment.Ethics and disseminationEthical approval has been obtained from South West-Central Bristol Research Ethics Committee. Publication of the MERIT study is anticipated to occur in 2021.Trial registration numberISRCTN 13283516.

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Evidence for Bladder Urothelial Pathophysiology in Functional Bladder Disorders

BioMed Research International ◽

10.1155/2014/865463 ◽

2014 ◽

Vol 2014 ◽

pp. 1-15 ◽

Cited By ~ 44

Author(s):

Susan K. Keay ◽

Lori A. Birder ◽

Toby C. Chai

Keyword(s):

Urinary Tract ◽

Interstitial Cystitis ◽

Pain Syndrome ◽

Upper Urinary Tract ◽

Bladder Pain Syndrome ◽

Bladder Function ◽

Voiding Function ◽

Bladder Pain ◽

Urinary Tract Symptoms ◽

Bladder Disorders

Understanding of the role of urothelium in regulating bladder function is continuing to evolve. While the urothelium is thought to function primarily as a barrier for preventing injurious substances and microorganisms from gaining access to bladder stroma and upper urinary tract, studies indicate it may also function in cell signaling events relating to voiding function. This review highlights urothelial abnormalities in bladder pain syndrome/interstitial cystitis (BPS/IC), feline interstitial cystitis (FIC), and nonneurogenic idiopathic overactive bladder (OAB). These bladder conditions are typified by lower urinary tract symptoms including urinary frequency, urgency, urgency incontinence, nocturia, and bladder discomfort or pain. Urothelial tissues and cells from affected clinical subjects and asymptomatic controls have been compared for expression of proteins and mRNA. Animal models have also been used to probe urothelial responses to injuries of the urothelium, urethra, or central nervous system, and transgenic techniques are being used to test specific urothelial abnormalities on bladder function. BPS/IC, FIC, and OAB appear to share some common pathophysiology including increased purinergic, TRPV1, and muscarinic signaling, increased urothelial permeability, and aberrant urothelial differentiation. One challenge is to determine which of several abnormally regulated signaling pathways is most important for mediating bladder dysfunction in these syndromes, with a goal of treating these conditions by targeting specific pathophysiology.

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Infections and inflammatory conditions

Oxford Handbook of Urology ◽

10.1093/med/9780198783480.003.0006 ◽

2019 ◽

pp. 193-251

Author(s):

John Reynard ◽

Simon F Brewster ◽

Suzanne Biers ◽

Naomi Laura Neal

Keyword(s):

Urinary Tract ◽

Pain Syndrome ◽

Clinical Problem ◽

Bladder Pain Syndrome ◽

Chronic Infections ◽

Antibiotic Resistant ◽

Bladder Pain ◽

Inflammatory Conditions ◽

Parasite Infections ◽

Tract Infections

This chapter covers all topics relating to genitourinary tract infections, including basic science and relevant microbiology. The commonest clinical problem of urinary tract infection (UTI) or cystitis is covered in depth, including investigation and management of recurrent UTI. The role of antibiotics both for treatment of active UTI and as prophylaxis is reviewed, along with alternative preventative therapies such methenamine and intravesical drugs. Common acute and chronic infections such as pyelonephritis, prostatitis, and epididymitis, and acute urological emergencies including urosepsis, urethral abscess, sepsis, and Fournier’s gangrene are described. Important chronic conditions including bladder pain syndrome/interstitial cystitis, ketamine bladder, phimosis, and inflammatory conditions of the penis are explained. Less common, but important, exam topics such as tuberculosis and parasite infections (schistosomiasis) of the urinary tract are covered, along with their adverse sequelae. The chapter also explores the essential and highly topical subjects of`antibiotic stewardship and the emergence of antibiotic-resistant organisms.

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