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Purpose To evaluate whether hydrodistention with fulguration of Hunner lesions (HD/FUL) plus maintenance dimethyl sulfoxide (DMSO) therapy prolongs the recurrence-free time in patients with Hunner type interstitial cystitis (IC). Methods The study enrolled patients with Hunner type IC who required repeat HD/FUL due to recurrence of IC symptoms after the first HD/FUL at our institution. All patients received a second HD/FUL plus maintenance DMSO therapy. The maintenance DMSO therapy was performed every 2 weeks for a total of 8 instillations, and then once every 4 weeks thereafter. The recurrencefree time from HD/FUL to therapeutic failure was estimated using the Kaplan-Meier method. The recurrence-free time between the first HD/FUL and second HD/FUL plus maintenance DMSO therapy was statistically compared using the log-rank test. Results A total of 21 patients (mean age, 66.3±10.8 years) with Hunner type IC were evaluated. The recurrence-free time for the second HD/FUL plus maintenance DMSO therapy was significantly longer than that for the first HD/FUL (P

Objective Ketamine-associated cystitis (KAC) has been described in a few case reports, but its treatment in a relatively large number of patients has not been documented. This study aimed to describe our experience of treatment of 36 patients with KAC. Methods Thirty-six patients (30 males and 6 females, aged 19–38 years) with KAC, who had previously taken a muscarinic receptor blocker and/or antibiotics, but without symptomatic relief, were treated with botulinum toxin A injection combined with bladder hydrodistention. Urodynamic testing, and the O’Leary–Sant interstitial cystitis symptom index (ICSI) and problem index (ICPI) were used to evaluate baseline values and improvement before and after the treatment. Results One month post-treatment, all patients achieved marked relief of symptoms. The nocturia time was markedly reduced, while bladder capacity, the interval between micturition, the void volume, and the maximum flow rate were remarkably increased at 1 month. Additionally, the ICSI and ICPI were significantly improved. Conclusion Botulinum toxin A injection along with bladder hydrodistention is effective for managing KAC.

Objective A retrospective review of long-term treatment outcomes for patients diagnosed with interstitial cystitis/painful bladder syndrome (IC/PBS) over a 10-year period. Materials and Methods Patients who were diagnosed with IC/PBS based on cystoscopic hydrodistention from 2001 to 2010 and thereafter received regular follow-up treatments were enrolled in this study. Clinical information was collected via a retrospective chart review. The following aspects were evaluated: treatment modalities and outcomes; symptom manifestation before and after treatments; and patients' perception on treatment effectiveness. The O'Leary–Sant Interstitial Cystitis Symptom Index (ICSI) and Interstitial Cystitis Problem Index (ICPI), and the Global Response Assessment Questionnaire were used as evaluation tools. Results A total of 54 patients with adequate clinical information were included for analysis in this study. The mean age was 38.11 ± 12.71 years and the female-to-male ratio was 3.15:1. The average follow-up duration was 30.61 ± 25.54 months. All patients had bladder or pelvic pain. Pretreatment urinary frequency and nocturia were 13.43 ± 5.09 times per day and 3.74 ± 2.18 times per night, respectively. Functional bladder capacity recorded from urinary diary was 228.1 ± 116.5 mL. Under anesthesia, bladder capacity at the start of a 10-minute therapeutic hydrodistention was 422.0 ± 197.5 mL, which increased to 542.9 ± 220.1 mL at the end of hydrodistention. No major complications were reported during and after the procedure. Additional treatments including oral medications and bladder instillation therapies were instituted in 98.1% of patients. Compared with pretreatment condition, the O'Leary–Sant ICSI and ICPI were decreased by 24% and 15.5%, respectively, after treatments. The subjective improvement rate, which was evaluated by the Global Response Assessment Questionnaire, was 81.6%. Conclusion Long-term continual treatments for IC/PBS are appreciated by most patients even though combinations of modalities are required and the improvements in symptoms and problems are only moderate.

Objective To assess the efficacy of hydrodistention (HD) followed by bladder training (BT) versus HD alone in patients with interstitial cystitis (IC). Methods A total of 70 patients with IC were included and randomly assigned to two groups: one treated with HD (HD group) and the other treated with HD plus BT (HD plus BT group). Each patient was followed up using a weekly diary for 8 weeks after HD and monthly thereafter for 6 months after HD. Evaluation parameters included age, duration of IC in years, how many doctors visited before treatment, urgency, bladder pain, daytime voided volume per void, nocturnal volume per void, daytime voids per day, and nocturia per day. Results Age, duration of IC in years, doctors visited before treatment, and voiding profiles of patients before treatments between the two groups did not show statistical significance. However, at 24 weeks after HD, the proportions of urgency, and bladder pain of the HD group versus the HD plus BT group were 43.48% versus 10.71% ( p = 0.008), and 34.78% versus 14.29% ( p = 0.086), respectively. Concurrently, the mean ± standard deviation of daytime voided volume per void, nocturnal volume per void, daytime voids per day, and nocturia per day of the HD group and HD plus BT group are 212.2 ± 114.2 mL and 300.1 ± 90.2 mL ( p = 0.005), 276.8 ± 113.0 mL and 360.0 ± 129.6 mL ( p = 0.018), 8.2 ± 3.2 and 6.2 ± 1.4 ( p = 0.010), and 2.2 ± 1.2 and 1.5 ± 0.7 ( p = 0.019), respectively. Conclusion HD followed by BT produced a statistically significantly better effect than HD alone in the treatment of patients with IC.

Results of this study suggest that patients who have failed therapies for overactive bladder might be more effectively treated using therapies directed towards uroepithelial dysfunction and neural upregulation associated with interstitial cystitis., Objective: We evaluated the prevalence of positive potassium sensitivity and cystoscopy with hydrodistention findings in patients with overactive bladder. Method: This was a prospective cohort study of 98 patients who presented with overactive bladder symptoms. The diagnosis of overactive bladder is established by the presence of irritable voiding symptoms. All patients completed a PUF questionnaire and underwent potassium sensitivity testing. Eighty patients underwent urodynamic testing, and 42 patients underwent cystoscopic hydrodistention while under general anesthesia. Results: The Potassium Sensitivity Test was positive in 59 (60.2%) of the 98 patients, 37 (56%) of wet overactive bladder patients, and 22 (68.8%) of dry overactive bladder patients. Their mean PUF score was 7. Thirty-three (78.5%) of the patients who underwent cystoscopic hydrodistention had glomerulations consistent with NIH criteria for interstitial cystitis, and 26 of these patients tested positive for potassium sensitivity. Fifty-one (63.8%) of the patients who underwent urodynamics tested positive for potassium sensitivity. Conclusion: Many patients with symptoms of overactive bladder with little or no pain have cystoscopic evidence of interstitial cystitis and a positive Potassium Sensitivity Test. Therapies directed toward the uroepithelial dysfunction and neural upregulation associated with interstitial cystitis/painful bladder syndrome may be an important adjunct for patients who have failed or have had a partial response to anticholinergic therapy and behavior modification.

Introduction: For bladder pain syndrome (BPS) refractory to conservative treatment, the European guidelines consider bladder hydrodistention (HD) under anaesthesia and the injection of Onabotulinumtoxin A (OnabotA) jointly. The objective of this study was to assess our experience in implementing this technique. Material and methods: A prospective study of 25 patients with BPS who underwent HD plus a submucosal injection of 100 U of OnabotA in trigone. The Hunner lesions were treated endoscopically using resection or electrocoagulation. Thirty-eight procedures were performed (25 first interventions and 13 reoperations). To study the clinical change, we evaluated the subjective improvement (Treatment Benefit Scale [TBS] and Patient Global Impression of Change [PGIC] scales), the visual analogue scale (VAS) for pain, the Bladder Pain/Interstitial Cystitis Symptom Score (BPIC-SS) questionnaire and the voiding diary for 3 days. For the data analysis, we employed the Wilcoxon, Kruskal-Wallis, Kaplan-Meier and log-rank tests. Results: We observed subjective improvement in 21 patients (84%), which was significant in 47% of these patients, moderate in 41.2% and slight in 11.8%. Four patients did not improve. A post-treatment reduction in the pain VAS (from 7.1 to 1.8 points; P=.001), in daytime (from 11.8 to 7.5; P=.012) and night-time (from 5.9 to 3.6; P=.003) voiding frequency and in the BPIC-SS (from 27.9 to 11.2 points; P=.042). The degree of improvement was not related to age, the presence of bladder lesions or the treatment of relapses. The median duration of improvement was 7 months (95% CI 5.69-8.31), although this duration was somewhat longer for the patients younger than 65 years. Mild complications occurred in 23.7% of the cases. Conclusions: The joint implementation of HD plus OnabotA is a valid therapeutic option in refractory BPS, which provides good clinical results and maintains its effectiveness in retreatments. (C) 2016 AEU. Published by Elsevier Espana, S.L.U. All rights reserved.

El objetivo de esta monografia es familiarizar al lector con la clasificacion de la hidrodistension dinamica del ureter y la metodologia de la tecnica de hidrodistension-implante para la correccion endoscopica del reflujo vesicoureteral (RVU). Revisamos las indicaciones, la tasa de exitos actual, sus complicaciones y las potencialesaplicaciones de estos metodos en el futuro. METODOS La hidrodistension del orificio ureteral y el ureter distal permite la visualizacion del sitio de inyeccion de la submucosa ureteral y la evaluacion del grado de coaptacion ureteral. Hemos designado cuatro niveles de hidrodistension. H0 ausencia de dilatacion ureteral, H1 dilatacion solo del orificio ureteral, H2 permite la visualizacion del ureter intramural y H3 permite la visualizacion del ureter extramural. El metodo de doble hidrodistension-implante es una tecnica sistematica que utiliza la hidrodistension para clasificar el ureter y evaluar el grado de coaptacion ureteral despues de la inyeccion endoscopica de sustancias de relleno. La aguja se inserta en el tunel medio ureteral a las 6 horarias. La primera inyeccion coapta el tunel en el detrusor (hasta conseguir H1 o H0), mientras que una segunda inyeccion mas distal en el tunel intramural lleva una coaptacion completa del orificio ureteral (H0). RESULTADOS El grado de hidrodistension se correlaciono significativamente con el grado de RVU. Mientras que los ureteres contralaterales no refluyentes demostraban grados bajos de hiperdistension, todos los ureteres que desarrollaron reflujo vesicoureteral posterior mostraban H2 o H3. El metodo de hidrodistension-implante no se ha empleado solo para RVU primario (90% de curaciones), sino tambien para inyecciones endoscopicas repetidas (90%), RVU asociado con diverticulo paraureteral (81%), casos complejos como despues de reimplante (88%), vejiga neurogena (78%), anomalias con duplicacion (80%), y en adultos (88%). Ademas, el ureter contralateral no refluyente que presenta hidrodistension puede tratarse para prevenir el RVU de novo. Mientras que con el metodo STING las tasas de exito disminuyen al aumentar el grado del RVU, con el metodo de hidro distension-implante se han visto mejores tasas de exitos. CONCLUSIONES La clasificacion de la hidrodistension dinamica refleja la competencia de la union ureterovesical. Los metodos de hidrodistension-implante simple y doble consiguen tasas de curacion superiores y probablemente se convertiran en el metodo de eleccion para el tratamiento del RVU primario y de los casos complejos.

Purpose: In the endoscopic treatment of vesicoureteral reflux, the relatively high rate of success, the simplicity of the procedure, high patient compliance, and a lack of complications has led to the increased development of injection materials and techniques. We report a method of identifying and maintaining a clear visual field during ureteral and bladder submucosal wall injection of a dextranomer/hyaluronic acid copolymer (Deflux, Oceana, Therapeutics Inc.) by use of the hydrodistention implantation technique (HIT) with the aid of temporary ureteral catheter insertion. Materials and Methods: We prospectively reviewed patients with grade IV or V reflux who received an endoscopic injection of Deflux. Reflux grade was evaluated before and after treatment (3 months) by use of voiding cystourethrograms. Conventional sub-trigonal injection (STING) was performed with injection of Deflux underneath the bladder mucosa at the 6 o’clock position. HIT was performed either with hydrodistention or with guidewire insertion. These techniques increase visualization of the intramural portion of the distal ureteral wall. Patients with treatment failures were offered reinjection up to three times. Results: Sixty-three patients completed endoscopic injection and follow-up of 3 months. The overall resolution rate for conventional STING was 58%, i.e., 67% for grade IV and 43% for grade V. The overall resolution rate for HIT was 80%, i.e., 93% for grade IV and 66% for grade V. The modified methods showed higher resolution rates for overall cure owing to the success in patients with grade IV reflux (p=0.026). Although the success of grade V treatment was higher with the modified method, the success rate was not statistically significant (p=0.27). Conclusions: HIT with the use of either hydrodistention or a guidewire to aid in visualization of the intramural portion of the distal ureter is an effective treatment for high-grade vesico-ureteral reflux.