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Background: Adhesive capsulitis (AC), more commonly known as "frozen shoulder", is a painful shoulder condition. The illness progresses through three phases: freezing, frozen and thawing. A gold standard treatment for adhesive capsulitis is not defined. The goal of any treatment is to reduce pain and restore shoulder movement. Objective: Objective of the present study is to evaluate the efficacy of gleno-humeral hydrodistension associated with physical therapy in patients with diagnosed adhesive capsulitis comparing the outcomes in term of pain and range of motion in patients with a phase 1 and a phase 2 disease. Method: Between January 2022 and April 2023, We evaluated 87 patients with adhesive capsulitis, 47 were excluded for others concomitant pathologies, finally 40 patients were enrolled for the study, of whom 23 had capsulitis in stage 1 and 17 in stage 2. Patients were evaluated at baseline and at 2, 4 and 6 months after infiltration recording range of motion in all planes, pain and functionality scores. Results: A significant improvement was recorded in shoulder range of motion in all planes with the except of extension in both groups. Phase 2 patients were able to regain shoulder range of motion in all planes except internal rotation which was recovered with more difficulty. Pain and functionality scores improved significantly between baseline and follow-up visits. Conclusion: Ultrasound-assisted hydrodistention of the glenohumeral joint combined with targeted exercise has been successful in improving pain relief, reducing disability, and increasing range of motion in subjects with stage 1 and 2 adhesive capsulitis, especially if diagnosed before phase 2 (when the range of motion is completely reduced). [ABSTRACT FROM AUTHOR]

Ultrasound-guided hydrodistention has been established as an effective minimally invasive treatment option for glenohumeral joint adhesive capsulitis (AC). Nonetheless, the long-term outcomes of the procedure have not yet been established. A total of 202 patients with AC were prospectively recruited and followed up for a total of 2 years. Pain and functionality were assessed with the use of the visual analogue scale (VAS) and the disabilities of the arm, shoulder, and hand (DASH) score, respectively, at the beginning and the end of the follow-up period. The relapse of AC over the 2-year period and the effect of diabetes were also evaluated in the treatment cohort. The Mann–Whitney U test was used to compare mean scores at the two time points, and Cox survival analysis and χ2 test were used to assess the effect of diabetes on AC relapse. VAS and DASH scores were significantly lower at 2 years compared with the beginning of the follow-up period (p < 0.001). Diabetes was diagnosed in 38/202 patients (18.8%) and was found to be significantly associated with recurrence of the disease (p < 0.001). In conclusion, in this observational study, we have demonstrated that ultrasound-guided hydrodistention is linked to excellent long-term outcomes for the treatment of AC, which are significantly worse in patients with diabetes.

Ultrasound-guided hydrodistention has been established as an effective minimally invasive treatment option for glenohumeral joint adhesive capsulitis (AC). Nonetheless, the long-term outcomes of the procedure have not yet been established. A total of 202 patients with AC were prospectively recruited and followed up for a total of 2 years. Pain and functionality were assessed with the use of the visual analogue scale (VAS) and the disabilities of the arm, shoulder, and hand (DASH) score, respectively, at the beginning and the end of the follow-up period. The relapse of AC over the 2-year period and the effect of diabetes were also evaluated in the treatment cohort. The Mann–Whitney U test was used to compare mean scores at the two time points, and Cox survival analysis and χ2 test were used to assess the effect of diabetes on AC relapse. VAS and DASH scores were significantly lower at 2 years compared with the beginning of the follow-up period (p < 0.001). Diabetes was diagnosed in 38/202 patients (18.8%) and was found to be significantly associated with recurrence of the disease (p < 0.001). In conclusion, in this observational study, we have demonstrated that ultrasound-guided hydrodistention is linked to excellent long-term outcomes for the treatment of AC, which are significantly worse in patients with diabetes. [ABSTRACT FROM AUTHOR]

Background: Certain procedures, particularly those used to treat symptoms of bladder pain syndrome/interstitial cystitis (BPS/IC), involve filling the bladder to or over its capacity for visualization and/or relief of symptoms. Rarely, if excessive pressure or volume is used, bladders may rupture causing significant harm to the patient. The purpose of this study was to identify baseline data for pressure and volume when hydrodistention is attempted in explanted cadaveric bladders, as well as determine bladder rupture pressure changes in the acute post-cystorrhaphy state. Methods: Eight explanted cadaveric bladders were filled using a systematic digital pump system. Intravesical pressure and volume were monitored during the filling phase until rupture. A two-layer cystorrhaphy was performed followed by bladder refilling to point of rupture. The pressure-volume correlations were developed for the explanted bladders, pre and post rupture. Results: The mean intact bladder rupture volume was 1186.3 mL ± 356.1 (range 450.0–1550.0) and mean pressure of 103.4 cm H2O ± 45.9 (range 59.0–190.0). The mean bladder rupture volume following repair was 1051.9 mL ± 251.3 (range 500.0–1300.0) while the mean pressure dropped to 53.1 cm H2O ± 44.0 (range 18.0–149.0). Compliance was noted to decrease significantly with a 54% drop in maximal pressure immediately prior to repeat rupture. Location of the initial rupture site did not have an impact on volume or pressures achieved. The weakest point post-cystorrhaphy consistently involved the original cystotomy site. Conclusions: This study provides ex-vivo bladder parameters that may guide providers in distention and post-rupture cases. Repeat rupture pressure (maximal bladder pressure achieved) and bladder compliance were noted to be significantly lower immediately post-cystorrhaphy.

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

Aims: Gene expression profiling of bladder biopsies in patients with interstitial cystitis/bladder pain syndrome (IC/BPS), typically obtained following therapeutic bladder hydrodistention (HOD), is used to improve our understanding of molecular phenotypes. The objective of this study was to determine if the HOD procedure itself impacts the biopsy gene expression profile and, by extension, whether biopsies from non‐HOD bladders are appropriate controls. Methods: Bladder biopsies were obtained just before HOD and immediately following HOD from 10 consecutively recruited IC/BPS patients undergoing therapeutic HOD. Biopsies were also obtained from four non‐IC/BPS patients who did not undergo HOD (controls). Total RNA was isolated from each of the 24 samples and used to query whole‐genome microarrays. Differential gene expression analysis was performed to compare expression profiles of IC/BPS biopsies before and after HOD, and between IC/BPS and control biopsies. Results: Principal component analysis revealed complete separation between gene expression profiles from IC/BPS and control samples (q ≤ 0.05) and while IC/BPS samples before and after HOD showed no significant differences in expressed genes, 68 transcripts were found to be significantly different between IC/BPS and control samples (q ≤ 0.05). Conclusions: The bladder HOD procedure itself does not significantly change gene expression within the IC/BPS patient bladder, a finding that provides evidence to support the use of biopsies from non‐IC/BPS patients that have not undergone HOD as controls for gene expression studies. [ABSTRACT FROM AUTHOR]

Purpose: We analyzed the long-term efficacy of simultaneous transurethral resection (TUR) and therapeutic hydrodistention in patients with ulcerative interstitial cystitis (IC) who did not experience recurrence on long-term follow-up. Methods: We studied 132 female patients (mean age = 56.45 ± 11.56 years) who underwent TUR followed by hydrodistention to treat ulcerative IC between January 2010 and January 2017, and who were available for follow-up, for more than 36 months (mean = 52.3 ± 10.51 months). Of the 132 patients, those who did not suffer recurrence within 36 months after surgery were allocated to group I and those who had a recurrence within the same period were assigned to group II. Preoperative factors, including age, were compared between the groups. In group I, improvements in pain and voiding symptoms were recorded using a 10-point visual analog pain scale (VAS) and a 3-day micturition chart. A global response assessment (GRA) was used to evaluate patient satisfaction. Results: In group II, the maximum functional bladder capacity (FBC) was smaller, and voiding frequency was higher, than in group I. Follow-up of patients in group I for more than 3 years showed that pain decreased after surgery. The 10-point VAS scores were 9.68 before surgery, and 1.54, 0.93, 0.55, and 0.46 at 1, 6, 12, and 36 months after surgery (p < 0.001), respectively. Maximum FBCs were 174.82 mL before surgery and 237.14, 250.71, and 254.46 mL at 1, 12, and 36 months after surgery (p < 0.001), respectively; thus, FBC increased after surgery. Urination frequency decreased significantly after surgery; the number of daily urinations was 12.77 before surgery, and 9.88, 9.21, and 9.25 at 1, 12, and 36 months after surgery (p < 0.001), respectively. Overall patient satisfaction improved after surgery; the GRA scores were 2.39, 2.71, and 2.8 points at 1, 12, and 36 months after surgery (p < 0.001), respectively. Conclusion: Upon simultaneous performance of TUR and therapeutic hydrodistention in patients with ulcerative IC, 49.2% showed favorable outcomes for 3 years. [ABSTRACT FROM AUTHOR]

Hydrodistention is one of the effective procedures for the diagnosis as well as treatment of interstitial cystitis and painful bladder syndrome and interstitial cystitis/painful bladder syndrome (IC/PBS). The present study was aimed to investigate the factors affecting the symptom-free period after hydrodistention in females with IC/PBS. In the present study, 32 IC/PBS females with symptom recurrence after hydrodistention who needed further management were included. Clinical information including age, duration suffered from the disease, preoperative functional bladder capacity (FBC), and the distended bladder volume during hydrodistention was investigated. Also, the symptom-free period after hydrodistention and the volume difference between preoperative FBC and distended bladder volume during the hydrodistention (ΔBV) was calculated for the analysis. As the result, ΔBV was the only factor that significantly elongated the symptom-free period after hydrodistention (p < 0.001). Thus, the larger volume difference between preoperative FBC and distended bladder volume during the first hydrodistention elongated the symptom-free period of IC/PBS females after receiving hydrodistention. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the clinical characteristics of nocturia in patients with interstitial cystitis (IC), and the effects of bladder hydrodistention (with fulguration of Hunner lesions) on nocturia. Methods: The records of 81 patients who were diagnosed with IC were reviewed. Clinical characteristics were evaluated using the Interstitial Cystitis Symptom Index (ICSI), a visual analogue scale (VAS), and bladder diary data. Differences in characteristics between Hunner‐ and non‐Hunner‐type IC were compared. Correlations between nocturia and other clinical variables were assessed. Stepwise multiple regression analysis was performed to identify factors associated with nocturia. Further, changes in nocturia before and after hydrodistention (with fulguration of Hunner lesions) were analyzed. Results: The mean (± SD) age of patients was 62.2 ± 15.3 years. Significant differences in nocturia were observed between Hunner‐ and non‐Hunner‐type IC. Nocturia was positively correlated with age, urgency score (ICSI and VAS), mean number of urgency episodes per 24 hours and the nocturnal polyuria (NP) index, and negatively correlated with average voided volume. Age, NP index, average voided volume, and the presence of Hunner lesions were independent factors associated with nocturia. Bladder hydrodistention significantly decreased nocturia in non‐Hunner type IC without NP. In addition, regardless of the presence or absence of NP, bladder hydrodistention with fulguration of Hunner lesions significantly decreased nocturia in Hunner‐type IC. Conclusions: The severity of nocturia is associated with age, NP, average voided volume, and the presence of Hunner lesions in IC patients. Bladder hydrodistention (with fulguration of Hunner lesions) has the potential to decrease nocturia. [ABSTRACT FROM AUTHOR]

A botulinum toxin A (BoNT-A) intravesical injection can improve the symptoms of interstitial cystitis/bladder pain syndrome (IC/BPS). Patients with IC/BPS have different clinical characteristics, urodynamic features, and cystoscopic findings. This study assessed the treatment outcomes of a BoNT-A intravesical injection and aimed to identify the predictive factors of a satisfactory outcome. This retrospective study included IC/BPS patients treated with 100 U BoNT-A. The treatment outcomes were assessed by global response assessment (GRA) at 6 months. We classified patients according to different clinical, urodynamic, and cystoscopic characteristics and evaluated the treatment outcomes and predictive factors. A total of 238 patients were included. Among these patients, 113 (47.5%) had a satisfactory outcome (GRA ≥ 2) and 125 (52.5%) had an unsatisfactory outcome. Improvements in the IC symptom score, IC problem score, O’Leary−Sant symptom score, and visual analog scale score for pain were significantly greater in patients with a satisfactory outcome than in patients with an unsatisfactory outcome (all p = 0.000). The IC disease duration and maximal bladder capacity (MBC) were significantly different between patients with and without a satisfactory outcome. Multivariate analysis revealed that only the MBC was a predictor for a satisfactory outcome. Patients with a MBC of ≥760 mL and glomerulations of 0/1 (58.7%) or glomerulations of 2/3 (75.0%) frequently had a satisfactory outcome. We found that BoNT-A intravesical injection can effectively improve symptoms among patients with IC/BPS, with a remarkable reduction in bladder pain. A MBC of ≥760 mL is a predictive factor for a satisfactory treatment outcome.

Interstitial cystitis (IC) has been described as a chronic debilitating sterile inflammatory multifactorial bladder syndrome of unknown etiology. IC is characterized by bladder pain (or suprapubic pain) associated with urgency, urinary frequency, and nocturia. Because the pathogenesis of IC remains unclear, it is still an enigma and represents a diagnostic and therapeutic challenge. The diagnosis of IC remains unclear and is based on exclusion of other diseases. Consequently, IC has usually been underdiagnosed, and the consensus on best available treatment for the disease is lacking. The current goal for the treatment of IC is usually symptomatic relief, and treatment protocols are based on empiricism. Multiple forms of therapy are available, and most patients can be managed conservatively. Nevertheless, the efficacy of most treatments is short term. This review article gives an overview of the available treatments for IC.

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.

Background Hydrodistention is known to be an effective method of treatment for frozen shoulder. However, hydrodistention is accompanied by severe pain during the procedure. An interscalene block may relieve the severe pain associated with the procedure of hydrodistention. This study compared the clinical efficacy of hydrodistention with joint manipulation under an interscalene block with that of intra-articular corticosteroid injection. Methods This prospective randomized controlled study included 121 patients presenting with frozen shoulder. Patients were randomized into 2 groups; those in group A (60 patients) were treated by hydrodistention with joint manipulation under an interscalene block, and those in group B (61 patients) were managed with intra-articular corticosteroid injection. Pain intensity and patient satisfaction were assessed by the visual analog scale. Functional outcomes were assessed by the Constant score and the range of shoulder motion. Results Group A demonstrated better patient satisfaction and earlier restoration of range of motion than group B at 6 weeks ( P  ≤ .001). At 12 weeks, the pain score was lower and the Constant score was better in group A than in group B. However, at 12 months after treatment, pain score ( P  = .717), patient satisfaction ( P  = .832), range of motion ( P  > .05), and Constant score ( P  = .480) were similar in the 2 groups. Conclusion Hydrodistention combined with joint manipulation under an interscalene block provided earlier pain relief and restoration of shoulder range of motion and function compared with single intra-articular corticosteroid injection in patients with primary frozen shoulder. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: To evaluate the efficacy and safety of the intravesical injection of Chinese botulinum toxin A (BTX-A) in patients with interstitial cystitis/bladder pain syndrome (IC/BPS). Methods: Between January 2003 and June 2013, 124 women with IC/BPS were studied. Of these 124 patients, 66 were treated with BTX-A and 58 underwent bladder hydrodistention plus sodium hyaluronate (Cystistat) instillation. Intravesical injection of 100 U of Chinese BTX-A was immediately followed by cystoscopic hydrodistention under intravenous general anesthesia. The patients were evaluated using the O'Leary-Saint score, a visual analog scale pain score, a urinary frequency record and a quality of life questionnaire before treatment and 1 week, and 1, 3, 6 and 12 months after treatment. Results: Of the patients who received BTX-A injection, only 2 had acute urinary retention, 23 received a repeat injection, and 20 were lost to follow-up. Of the patients treated with hydrodistention plus Cystistat instillation, 2 had urinary tract infection, 11 switched to BTX-A injection at 6 months, and 23 were lost to follow-up. BTX-A was shown to remain effective for up to 6 months after treatment. After repeated Chinese BTX-A injections, symptoms improved significantly. Hydrodistention plus Cystistat remained effective for up to 3 months after treatment. Conclusions: Intravesical injection of Chinese BTX-A is a safe and effective therapeutic option for patients with IC/BPS. The average duration of the effect of one dose of Chinese BTX-A amongst the responders was 6 months. Repeated injection of Chinese BTX-A is safe and effective. [ABSTRACT FROM AUTHOR]

Abstract: 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. [Copyright &y& Elsevier]

Introduction and hypothesis: The purpose of this study was to investigate change in bladder capacity as a measure of response to combined intravesical dimethyl sulfoxide (DMSO) and triamcinolone instillations for the treatment of newly diagnosed bladder pain syndrome/interstitial cystitis (BPS/IC). Methods: 141 newly diagnosed women were identified retrospectively. 79 were treated with weekly DMSO/triamcinolone instillations. Change in bladder capacity with bladder retrofill, daytime urinary frequency, nocturia episodes per night, and Likert scale symptom scores were reviewed. Wilcoxon signed-rank tests, Wilcoxon rank-sum tests, Spearman's rank correlations, COX regression analysis, and a Kaplan-Meier survival curve were performed. Results: Significant changes (median (25-percentile to 75-percentile) were noted for bladder capacity (75 mL (25 to 130 mL), p < 0.0001), inter-void interval (0 hrs (0 to 1 hour), p < 0.0001), nocturia episodes per night (−1 (−2 to 0), p < 0.0001), and aggregate Likert symptom scores (−2 points (−5 to 0), p < 0.0001). Percent change in bladder capacity correlated positively with percent change in inter-void interval (p = 0.03) and negatively with percent changes in nocturia (p = 0.17) and symptom scores (p = 0.01). Women without detrusor overactivity (DO) had greater percent changes in capacity than women with DO (62.5 % vs. 16.5 %, p = 0.02). 61.3 % of patients were retreated with a 36 weeks median time to retreatment and no difference in time to retreatment based upon DO. Greater capacity was protective against retreatment (hazard ratio = 0.997 [95 % CI 0.994,0.999], p = 0.02). Conclusions: Percent change in bladder capacity is a useful objective measure of response to intravesical DMSO/triamcinolone for newly diagnosed BPS/IC. Clinical outcomes do not differ based upon presence of DO. [ABSTRACT FROM AUTHOR]

OBJECTIVE To compare the clinical effectiveness of botulinum toxin type A (BoNT-A) injections followed by hydrodistention (HD) with HD alone in patients with interstitial cystitis/painful bladder syndrome (IC/PBS). PATIENTS AND METHODS A prospective, randomized study was performed in a urological referral centre. In all, 67 patients with IC/PBS who had failed conventional treatments were enrolled. Of these, 44 patients received suburothelial injection with 200 U (15) or 100 U (29) of BoNT-A followed by cystoscopic HD 2 weeks later (BoNT-A groups). The control group (23 patients) received the identical HD procedure with no BoNT-A injection. All patients remained on baseline medications of pentosan polysulphate throughout the study. Bladder pain visual analogue scale (VAS), O’Leary-Sant symptom and problem indexes, functional bladder capacity (FBC) and urodynamic variables were measured at baseline and after treatment. Global response assessment was used to evaluate successful treatment response. RESULTS The IC/PBS symptom score significantly decreased in all three groups, but VAS reduction, FBC and cystometric bladder capacity increases were significant only in the BoNT-A groups at 3 months. Of the 44 patients in the BoNT-A group 31 (71%) had a successful result at 6 months. A successful result at 12 and 24 months was reported in 24 (55%) and 13 (30%) patients in BoNT-A group, respectively, compared with only six (26%) and four (17%) in the control group ( P = 0.002). CONCLUSION Intravesical injections of BoNT-A followed by HD produced significantly better clinical results than HD alone in patients with IC/PBS. [ABSTRACT FROM AUTHOR]

Abstract: Study Objective: Chronic pelvic pain is often a manifestation of interstitial cystitis (IC), for which several symptom scoring measures exist. However, the receiver operating characteristic (ROC) curves for these scores have not been described, even though such analysis could identify an optimal noninvasive test and suggest diagnostic test thresholds. The objective of this study was to develop ROC curves for IC symptom scores based on the standard of pain relief after cystoscopy with hydrodistention (HD). Design: This is a retrospective analysis of IC symptom index (ICSI) and visual analog scale (VAS) bladder pain (VASb) scores recorded at initial patient visit. Patients underwent a diagnostic algorithm leading to selected HD. The ROC curves were calculated based on the presence of diagnostic criteria for IC found at HD (Canadian Task Force classification III). Setting: A multidisciplinary chronic pelvic pain referral center. Patients: A total of 277 women with chronic pelvic pain were evaluated. The mean duration of pain was 54 months; mean pelvic pain VAS score was 7.5. Those proved to have IC had a VASb score of 7 and an ICSI score of 11. Interventions: Initial symptom score tabulation followed by a symptom-based diagnostic algorithm consisting of alkalinized lidocaine instillation with HD offered to responders. Measurements and Main Results: The ROC curve for the VASb was shifted to the upper left compared with the ICSI, which was closer to the diagonal. Area under the curve was significantly greater for VASb (0.860) than ICSI (0.773) (p=.045). The maximum diagnostic accuracy for the ICSI was at a value of 14 or more (0.88) and for the VASb at a value of 7 or more (0.94). Conclusion: The most accurate symptom score for detecting IC based on this analysis was the VASb with a threshold of 7. Although the ICSI may have use, in this setting it is not as useful as the VAS for identifying patients who eventually prove to have IC. [Copyright &y& Elsevier]

Objective: To determine the efficacy of hydrodistention of the bladder for symptomatic treatment of interstitial cystitis after 6 months and 1 year of follow-up and to identify a predictive factor.Methods: The study included 65 consecutive patients (a first retrospective series of 33 and a second prospective series of 32) treated by hydrodistention of the bladder for urinary symptoms attributed to interstitial cystitis. All experienced pain on bladder filling, which was relieved by micturition or bladder voiding, and had more than two nocturias. Glomerulations were detected at short hydrodistention during cystoscopy. No patients were subject to NIH exclusion criteria. Hydrodistention was performed continuously for 3 h without rest intervals under epidural anesthesia using a balloon with a pressure equal to the patient’s mean arterial pressure. Efficacy was defined as the disappearance of pain on bladder filling or the persistence of moderate, non-disabling pain for which the patient did not request treatment, and a low frequency of nocturia (zero to two times). The efficacy period was estimated according to Kaplan–Meier methods for survival curves. The second series was used to verify the analytic results of the first series.Results: Treatment efficacy was 12/32 (37.7% CI: 20.7–54.3) at 6 months and 7/32 (21.9% CI: 7.6–36.2) at 1 year for the first series, and 18/30 (60.0% CI: 45.0–75.0) at 6 months and 13/30 (43.3% CI: 25.6–61.1) at 1 year for the second series. In both series, results were better for the subgroup of patients with a bladder capacity ≥150 ml during cystometry before distention.Conclusions: This study showed good but transient efficacy in the least developed or least severe forms of the disease. [Copyright &y& Elsevier]

Intravesical instillation of platelet-rich plasma has the potential to improve symptoms and reduce pain in patients who have interstitial cystitis and painful bladder syndrome by utilizing the body's own growth factors found in platelets. Interstitial cystitis is a disease of the bladder that causes pain, urinary frequency, urgency, and nocturia. It is difficult to treat and has unknown etiology. Patients who have interstitial cystitis have high rates of anxiety as a comorbid condition. People with anxiety are known to have dysregulation of serotonin. These concepts are interrelated., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Hardy et al.)

Background: To illustrate the bladder autoaugmentation by transurethral vesicomyotomy (BATV) and compare the efficacy and safety of BATV to bladder hydrodistention (BH) for managing ketamine cystitis (KC)., Methods: We retrospectively analyzed clinical data for 53 patients with KC who received surgical intervention between 2014 and 2019 at our hospital. Of these, 41 (77.4%) underwent BH and 12 (22.6%) were subjected to BATV, with a minimum of 1-year follow-up. These groups were compared with reference to urodynamic parameters, subjective symptom scores as well as all complications., Results: Both groups were matched in age, addiction time, preoperative urodynamic parameters, postvoid residual urinary volume (PVR), and symptom scores. All urodynamic parameters including maximum cystometric capacity (MCC), maximum detrusor pressure (P det max ), compliance, maximum urinary flow rate (Q max ) and symptom scores had improved significantly in two groups whether at 3 or 12 months. Moreover, the MCC was significantly increased after BATV than BH, at a mean [standard deviation (SD)] of 281.0 (25.7) vs. 213.5 (35.6) mL (P<0.001) at 12-month follow-up. The Q max and the Pelvic Pain and Urgency/Frequency (PUF) symptom score were still noted better in the BATV group at 3 months after surgery. Additionally, patients in both groups had similarly low rates of complications., Conclusions: BATV is superior to BH with increased bladder capacity and urodynamic outcomes, although showing equivalent in symptom relief and a similar rate of complications., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tau-21-188). The authors have no conflicts of interest to declare., (2021 Translational Andrology and Urology. All rights reserved.)

A botulinum toxin A (BoNT-A) intravesical injection can improve the symptoms of interstitial cystitis/bladder pain syndrome (IC/BPS). Patients with IC/BPS have different clinical characteristics, urodynamic features, and cystoscopic findings. This study assessed the treatment outcomes of a BoNT-A intravesical injection and aimed to identify the predictive factors of a satisfactory outcome. This retrospective study included IC/BPS patients treated with 100 U BoNT-A. The treatment outcomes were assessed by global response assessment (GRA) at 6 months. We classified patients according to different clinical, urodynamic, and cystoscopic characteristics and evaluated the treatment outcomes and predictive factors. A total of 238 patients were included. Among these patients, 113 (47.5%) had a satisfactory outcome (GRA ≥ 2) and 125 (52.5%) had an unsatisfactory outcome. Improvements in the IC symptom score, IC problem score, O'Leary–Sant symptom score, and visual analog scale score for pain were significantly greater in patients with a satisfactory outcome than in patients with an unsatisfactory outcome (all p = 0.000). The IC disease duration and maximal bladder capacity (MBC) were significantly different between patients with and without a satisfactory outcome. Multivariate analysis revealed that only the MBC was a predictor for a satisfactory outcome. Patients with a MBC of ≥760 mL and glomerulations of 0/1 (58.7%) or glomerulations of 2/3 (75.0%) frequently had a satisfactory outcome. We found that BoNT-A intravesical injection can effectively improve symptoms among patients with IC/BPS, with a remarkable reduction in bladder pain. A MBC of ≥760 mL is a predictive factor for a satisfactory treatment outcome. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether the O'Leary-Sant Interstitial Cystitis Symptom Index (ICSI) and Interstitial Cystitis Problem Index (ICPI) is efficacy measure tool for interstitial Cystitis (IC) treatment with hydrodistention (HD) and bladder training (BT)., Materials and Methods: From January 2003 to March 2006, 108 consecutive IC patients were treated by HD and BT after HD. This study evaluated the efficacy of treatment with the specific questionnaire for IC, the ICSI and ICPI. Each patient filled out the questionnaire before HD and three months after HD and BT. The efficacy of the treatment was evaluated using the average scores of ICSI and ICPI., Results: The mean ± margin of error, (95% confidence interval) of total scores of ICSI and ICPI were 13.89 ± 2.95, (13.33-14.45) and 12.51 ± 2.50, (12.04-12.98) before HD, respectively, and were 2.70 ± 1.16, (2.44-2.95) and 1.99 ± 1.27, (1.71-2.26) (all p < 0.005) three months after HD and BT, respectively., Conclusion: O'Leary-Sant ICSI and ICPI is not only a screening tool for IC but also a useful assessment tool for IC treatment outcomes., (Copyright © 2018. Published by Elsevier B.V.)

Summary Introduction/Objective The dynamic hydrodistention (HD) classification is a basic and objective way of rating the ureteral orifice opening. This study evaluated the value of hydrodistention of the ureteral orifice in the diagnosis of vesicoureteral reflux (VUR). Material and methods Between January 2012 and March 2013 the HD grade in 106 ureters was prospectively assigned. A 9.5-Fr rigid cystoscope with a 0-degree lens was used in all procedures. Warm saline was used and the irrigation bag was placed approximately 1 m above the bladder level on full flow. The grading is as follows: H0 denotes absence of ureteral dilation; H1 indicates dilation of the ureteral orifice only; H2 allows visualization of the intramural ureter; and H3 allows visualization of the extramural ureter. Indications for cystoscopy were endoscopic and open surgical treatment of VUR, stent removal, and any other diagnostic reasons. Exclusion criteria were patients with: infravesical obstruction, neuropathic bladder, severe detrusor over activity/dysfunctional voiding, duplex system, paraureteral diverticulum, bladder exstrophy and grade-1 VUR. The 51 refluxing ureters (RUs) were compared with 55 non-refluxing ureters (NRUs). Finally, sensitivity, specificity, positive and negative predictive values, and accuracy rate of HD were evaluated. Results A total of 106 ureters in 61 patients with a mean age of 5.3 ± 3.9 years (range 2 months–15 years, median 5 years) were prospectively assigned. The mean HD grade in the RUs was 2.17 ± 0.55. The mean HD grades were 2.0 ± 0.63, 2.07 ± 0.53, 2.38 ± 0.5 and 2.5 ± 0.57 for VUR grades 2–5, respectively. The mean HD grade in the NRUs was 1.60 ± 0.70. The HD grades were H0 to H3 in 7.3%, 30.9%, 56.4% and 5.4% of the NRUs, respectively. The RUs group (2.17 ± 0.55) showed a statistically higher HD grade than the NRUs group (1.60 ± 0.70) ( P < 0.005). Sensitivity, specificity, positive and negative predictive values, and accuracy rate of HD grading in the diagnosis of VUR were 92%, 38%, 58%, 84%, and 64%, respectively. The mean HD grade in contralateral ureters of unilateral VUR was 1.55 ± 0.72 and HD grades were H0–H3 in 0%, 55.6%, 33.3% and 11.1% of these nine ureters, respectively. In these nine non-refluxing contralateral ureters, after endoscopic correction of ipsilateral VUR, new contralateral VUR did not occur. Conclusion Even though HD grade was high in the VUR group and popularity of the HD grading is on the increase, HD grading by itself still has a low diagnostic value. [ABSTRACT FROM AUTHOR]

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., (Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objectives: Ketamine abuse can damage the urinary tract and cause lower urinary tract symptoms (LUTS). This report presents our observations and management on urinary tract damage caused by ketamine abuse., Methods: From November 2006 to February 2009, 20 patients visited Taipei Veterans General Hospital due to ketamine-related lower urinary tract symptoms. We analyzed the clinical presentations, daily ketamine dose, interval between ketamine usage to develop LUTS, urodynamic studies, radiological image findings, cystoscopic and ureterorenoscopic findings, histological findings, urinary ketamine levels and treatment responses., Results: Of these 20 patients, all had moderate to severe LUTS, including frequency, urgency, dysuria and hematuria. The mean daily consumption of ketamine was 3.2 ± 2.0 g. The mean interval from consumption to the development of LUTS was 12.7 months (range, 2-36 months). Eight patients underwent video urodynamic studies, with a mean cystometric capacity of 70.8 mL. Eight patients had hydronephrosis and six of them underwent ureterorenoscopy. All patients underwent cystoscopy with hydrodistention. Mean bladder capacity under anesthesia was 289.9 mL, and 14 (70%) patients showed significant symptomatic improvement after hydrodistention. Ten patients quit ketamine and nine (90%) experienced symptomatic relief. The response rates of symptomatic improvement to each treatment were 75% (12/16) for oral pentosan polysulfate sodium with prednisolone, 40% (2/5) intravesical instillation of xylocaine and heparin, and 0% (0/2) for intravesical instillation of hyaluronic acid., Conclusions: Ketamine abuse causes damage to the upper and lower urinary tracts. While ketamine abuse is an illicit drug problem, it is also associated with serious urological damage., (© 2011 Blackwell Publishing Asia Pty Ltd.)

Painful bladder syndrome/interstitial cystitis (PBS/IC) is a condition of chronic pelvic pain associated with irritative voiding symptoms. Management of PBS/IC has been a challenge for generations of physicians, owing to a lack of consensus on its definition, an incompletely understood pathophysiology, and numerous available therapies without high-quality evidence to guide their usage. This article reviews the most current conception of PBS/IC and data on effective treatments to recommend a management strategy.