RESUMEN
In non-muscle invasive bladder cancer, Bacillus Calmette-Guérin (BCG) responders benefit from strong Th1-type inflammatory and T cell responses mediating tumor rejection. However, the corresponding lack of anti-inflammatory Th2-type immunity impairs tissue repair in the bladder wall and facilitates the development of cystitis, causing urinary pain, urgency, incontinence, and frequency. Mechanistically, the leakage of the glycosaminoglycan (GAG) layer enables an influx of potassium ions, bacteria, and urine solutes towards the underlying bladder tissue, promoting chronic inflammation. Treatments directed towards re-establishing this mucopolysaccharide-based protective barrier are urgently needed. We discuss the pathomechanisms, as well as the therapeutic rationale of how chondroitin and hyaluronic acid instillations can reduce or prevent BCG-induced irritative bladder symptoms. Moreover, we present a case series of five patients with refractory BCG-induced cystitis successfully treated with combined chondroitin and hyaluronic acid instillations.
RESUMEN
Introduction: The aim of this study was to assess the detrusor underactivity (DUA) prevalence of females with symptomatic anterior pelvic organ prolapse (POP) and to evaluate the relationship between DUA and POP stage. Material and methods: This was a prospective study recruiting women with symptomatic anterior POP. Patients with symptomatic stage 2-4 POP quantification system (POP-Q) who underwent urodynamics (UD) between January 2018 and April 2021 were included. Results: Data on 330 women (mean age 63.7 ±18.4 years old) with anterior vaginal wall defect were enrolled. Concomitant apical defect (uterine/vaginal vault) requiring surgical correction was diagnosed in 38 women (11.5%). DUA was found in 166 females (50.3%). In DUA women, POP-Q stage 2 was found in 45.2%, stage 3 in 50.9% and stage 4 in 76.5%. Only stage POP-Q stage 4 showed a statistically significant difference between DUA and non-DUA females (p 0.006). Conclusions: In women with symptomatic POP, regardless of the POP-Q stage, the chance of DUA occurrence was high. DUA was diagnosed in approximately half of the women undergoing UD for symptomatic POP, and it was three-fold higher in cases of POP-Q stage 4. Due to the high incidence of DUA in POP-Q 4 stage, it may be advantageous to identify and treat prolapse before they progress to stage 4.
