| Objective1. To do preliminary assessment of clinical incidence of painful bladdersyndrome/ interstitial cystitis in several hospitals,outpatients of Nanjing. To improvethe detection rate of painful bladder syndrome/ interstitial cystitis. To raise urologists,cognitive aspects of this disease simultaneously. To analyze results fromepidemiology study and provide epidemiological basis for clinical diagnosis andtreatment. To explore approaches for effective diagnosis and therapy.2. To give intervention therapy to part of confirmed patients who were voluntaryto accept treatment.To observe efficacy and safety of instillation of sodiumhyaluronate and intravesical botulinum toxin A injections for the female patients withpainful bladder syndrome/ interstitial cystitis .Methods1. The clinical data of patients with painful bladder syndrome/ interstitialcystitis(from November 2008 to December 2010) were from several hospitals,urologyoutpatients of Nanjing. Doing questionnaires survey on outpatients with mainsymptoms like urinary urgency, urinary frequency, suprapubic pain or pelvic painrelated to full bladder but without urinary infection or benign prostatic hyperplasia.Screening suspicious patients and establishing patient database. Using PUF (pelvicpain and urgency / frequency patient symptom scale) and NIDDK (the nationalinstitute of diabetes, digestive and kidney diseases) diagnostic criteria. By urineculture, looking for urinary exfoliated cells, looking for acid-fast bacilli in urine,urodynamics, B ultrasound of urinary system, potassium sensitivity test,hydrodistention under anesthesia and bladder mucosal random biopsy and other testsexcluding specific diseases like urinary and reproductive tract infections, cancer, tuberculosis causing lower urinary tract symptoms. Analyzing factors related to itsincidence.2.41 cases of female patients with painful bladder syndrome / interstitial cystitiswho were voluntary to accept treatment were randomly divided into two groups.22cases of them were treated by instillation of sodium hyaluronate(group A), and theother 19 patients were given intravesical botulinum toxin A (group B).Patients wereasked to record voiding diary. Regular follow-up was also required. Clinicalsymptoms (micturition frequency per day, odynuria degree score), O,Leary-Santsymptom and problem index and urodynamics index (volume at the first desire tovoid, maximum cystomatric capacity and maxium flow rate)were assessed at baselineand then again after 1, 3 and 6 months. Side effects were recorded at the same time.Compare two therapies,curative effect and side effects , and assess their efficacy andsafety.Results:1. 278 outpatients sent valid questionnaires. There were 82 male patients, and196 female. 84 of them got a over 15 PUF score. After urine culture, looking forurinary exfoliated cells, looking for acid-fast bacilli in urine, urodynamics, Bultrasound of urinary system, 6 patients were excluded. The remaining 78 patientswere given potassium sensitivity test . And 71 of them gained a positive result. Thepositive rate of potassium sensitivity test was 91.0%. The last procedure werehydrodistention under anesthesia and bladder mucosal random biopsy. Finally 52patients were confirmed painful bladder syndrome / interstitial cystitis. They were allfemale, aging from 21 to 67. The average age was (52.3±10.7) years. Course ofdisease was from 40 to 120 months. The average course was (58.6±12.1) months.Most of them were in 51-60 and 41-50 age group. The percentage were 42.3% and30.8%. The detection rate of painful bladder syndrome / interstitial cystitis was 18.7%.The incidence of PBS/IC may be related to age, loving stimulating foods and having ahistory of gynecological infection. The odd ratios were 3.37, 2.70 and 3.24respectively. There were significant differences(P<0.01)2. Before therapy and after therapy, all indexes of two groups patients had significant differences(P<0.05). Before therapy and after 1 month, clinical symptoms,O,Leary-Sant symptom and problem index between two groups had no significantdifferences(P>0.05). After 3 and 6 months, there were significant differences betweentwo groups (P<0.05). Before therapy, after 1 month and after 3 months , urodynamicsindex between two groups had no significant differences(P>0.05). After 6 months,there were significant differences between two groups (P<0.05). Instillation ofsodium hyaluronate therapy had no adverse effects. There were three patients who gotdysuria in BTX-A injections group, no other side effects. There were 2 patients ingroup A and 1 in group B who had mild macroscopic hematuria after receivinghydrodistention under anesthesia. One patient in group A suspended because of heartdisease. The other patients had stable vital sign in the whole treatment and follow-upvisit.Conclusion:1. Painful bladder syndrome / interstitial cystitis mostly happened to women,especially in middle-aged elderly people. Age(more than 40), loving stimulatingfoods and having a history of gynecological infection may be related to its incidence.The main clinical symptoms were urinary frequency, urgency and suprapubic pain orpelvic pain related to full bladder. Urinary frequency and pain were in varyingdegrees. Most of the patients,results with potassium sensitivity test were positive,suggesting that the pain came from the bladder and the bladder mucosa permeabilityhad been raised. Potassium sensitivity test has a high positive rate and sensitivity.Combination of PUF score, NIDDK diagnostic criteria and PST test can improvediagnostic accuracy.2.Instillation of sodium hyaluronate therapy can effectively relieve clinicalsymptom of IC/PBS, increase bladder capacity and improve patients,quality of life.Patients were well tolerated. It had a longer effect and safety. Intravesical BTX-Ainjections had a short-term benefit, and it caused some side effects such as voidingdifficulty, which lasted several months until the effect of the treatment wore off.Comparing their efficacy and safety, instillation of sodium hyaluronate therapy issuperior to intravesical BTX-A injections. |
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