Hydrodistention plus bladder training versus hydrodistention for the treatment of interstitial cystitis.

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.

High-dose misoprostol as an alternative therapy after failed medical abortion.

OBJECTIVE: The aim of this study was to determine the complete abortion rate for the vaginal administration of high-dose misoprostol after a failed medical abortion. MATERIALS AND METHODS: When their medical abortions failed after the conventional oral administration of mifepristone and misoprostol, participants then received 1,000 microg of misoprostol vaginally. The efficacy and side effects of this treatment were evaluated. RESULTS: Twenty-seven women who failed to abort after the conventional administration of mifepristone and misoprostol were enrolled in this trial. Fourteen days after the vaginal administration of 1,000 microg misoprostol, the overall complete expulsion rate had reached 88.8% (24/27). Most adverse effects were mild to moderate and did not require treatment. CONCLUSION: The vaginal administration of 1,000 microg misoprostol as a salvage therapy after a failed medical abortion appears to be a safe and highly effective alternative to surgical intervention.

Efficacy of treating abdominal wall pain by local injection.

OBJECTIVE: When a patient's chief complaint is lower abdominal pain, but physical and ultrasonic examinations and laboratory tests show no evidence of any noticeable disease, physicians may make a wrong diagnosis, such as abdominal adhesion, chronic pelvic inflammatory disease, pelvic congestion and even psychosomatic disorders. In actuality, the pain may originate from the abdominal wall instead of the viscera. Local anesthetics coupled with steroid injections not only effectively alleviate the pain but also means that laparoscopy and medication can be avoided and is thereby worthy of wide use. Here, we present the results for the treatment of abdominal wall pain by local injection. MATERIALS AND METHODS: Between January 1994 and December 2005, we treated 211 abdominal wall pain patients. Diagnoses were based on the pressure of the abdominal wall tender point, which elicited sharp shooting pain during compression, and presence of positive Carnett's sign. After confirmation of the trigger point, a fine needle was used to inject a mixture of 0.5% bupivacaine 2 mL, 2% lidocaine 3 mL and 4 mg betamethasone 1 mL. The patients were examined on a weekly basis and underwent reinjection if symptoms recurred. RESULTS: There were 71 patients who were lost to or refused treatment or follow-up; the 140 remaining patients were evaluated. After trigger point injection in these patients, 95 (67.9%) reported no pain at all after treatment. Forty-five (32.1%) patients still had abdominal pain and required a second injection. A total of 133 (95%) patients showed complete pain resolution. After 3 months of follow-up, 115 (86.5%) patients remained free of abdominal pain. CONCLUSION: Local injection for selective abdominal wall pain patients produces significant pain relief. The diagnosis of abdominal wall pain is an important component in avoiding unnecessary operations in patients with abdominal pain.