Therapeutic effect of modulating the NLRP3-regulated transforming growth factor-ß signaling pathway on interstitial cystitis/bladder pain syndrome.

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a disorder with complex pathogenesis and lacks effective treatment. Chronic inflammation is the main pathogenesis of Hunner-type IC/BPS. The NLR family pyrin domain-containing 3 (NLRP3) inflammasome-related transforming growth factor-ß (TGF-ß)/Smad signaling pathway plays a crucial role in inflammation-related tissue fibrosis. Lipopolysaccharide (LPS) and protamine sulfate (LPS/PS) were instilled into the mouse bladder twice a week for 5 consecutive weeks to establish a chronic inflammation-induced IC/BPS model (LPS/PS model). Following LPS/PS treatment, curcumin (oral, 100 mg/kg; a potent NLRP3 modulator) was administered for 2 weeks in the curcumin treatment group, and normal saline was used for the sham group. Bladder function was evaluated by performing the voiding spot assay and examining the status of urothelial denudation and fibrosis in bladder tissues. The expression of NLRP3 inflammasome, interleukin-1ß, TGF-ß, Smad, vimentin, and E-cadherin in bladder tissues was evaluated through immunohistochemistry staining. Results revealed that the repeated instillation of LPS/PS leads to voiding dysfunction, bladder urothelium denudation, and detrusor muscle fibrosis through the upregulation of the NLRP3 inflammasome/IL-1ß-related TGF-ß/Smad pathway and the increased epithelial-mesenchymal transition process in bladder tissues. The downregulation of the NLRP3 inflammasome/IL-1ß-related TGF-ß/Smad pathway in bladder tissues through curcumin effectively mitigated bladder injury in the LPS/PS model. In conclusion, the NLRP3 inflammasome/IL-1ß-related TGF-ß/Smad pathway plays a crucial role in bladder injury in the LPS/PS model, and modulation of this pathway, such as by using curcumin, can effectively mitigate the sequelae of chronic inflammation-induced IC/BPS.

The clinical effect of traditional chinese medicine on middle-aged women with Interstitial Cystitis: Protocol for a randomized controlled trial.

INTRODUCTION: Interstitial cystitis (IC), as a common disease in urology, is prolonged and repeated. IC has caused great harm to the patient's physical and psychological. Traditional Chinese medicine (TCM) is characterized by overall concepts and dialectical treatment. It provides clinicians with safer and more reliable alternatives in terms of clinical prescriptions and prepared medicines, and also improves the quality of life of patients with IC. Therefore, in this study, we will use the research method of randomized controlled trials to explore the effects of TCM combined with western medicine on renal function and urine metabolism on middle-aged women with IC. METHODS/DESIGN: Use randomized controlled trials. According to the proposed diagnostic, inclusion, and exclusion criteria. Sixty patients with interstitial bladder inflammation that met the criteria were randomized into a treatment group and a control group of 30 cases each. The intervention group was treated with integrated traditional Chinese and western medicine. The control group was given conventional Western medicine treatment. The course of treatment is 8 weeks. Interstitial bladder inflammation symptoms score (ICS worker), problem score (worker CPI), pelvic pain and urinary urgency symptoms, and urodynamics were used as the evaluation criteria. DISCUSSION: This trial may provide evidence regarding the clinical effectiveness, safety, and cost-effectiveness of TCM for patients with IC. TRIAL REGISTRATION: ClinicalTrials.gov, ChiCTR2000029971, Registered on 17 February 2020.

Long-standing nonulcerative bladder pain syndrome: Impact of Thiele massage on bladder and sexual domains.

PURPOSE: To assess the efficacy of Thiele massage (TM) as monotherapy for nonulcerative interstitial cystitis/bladder pain syndrome (IC/BPS). METHODS: A prospective evaluation of 40 women with IC/BPS who underwent TM was conducted. TM was initially administrated by a physiotherapist and then self-administrated at home twice weekly for 16 weeks. Patients were assessed every 4 weeks on an outpatient basis. Assessment tools included 3-day voiding diaries, the Likert visual analog scale (VAS) for pain, and the Interstitial Cystitis Symptom Index (ICSI) and the Interstitial Cystitis Problem Index (ICPI) of the O'Leary-Sant questionnaire. Sexual function was assessed using the Female Sexual Function Index (FSFI). RESULTS: Thirty-six patients completed the study with a mean age ± SD 41.31 ± 9.93 (range 21-60 years). The mean duration of illness ± SD was 81.29 ± 34.55 (range 12-300 months). Perception of pain was higher than at basal level according to Likert VAS (9.2 ± 1.5 vs 9.8 ± 0.5, P = .018). The ICSI and ICPI questionnaires were deteriorated (16.83 ± 2.57 vs 12.89 ± 3.50, P = .015 and 15.75 ± 0.94 vs 14.31 ± 2.55, P < .001, respectively). TM had no significant impact on the total score of FSFI (P = .119); however, there was a negative impact on the lubrication domain with more dryness (0.045). CONCLUSIONS: TM is not an effective option as monotreatment modality for nonulcerative IC/BPS. An attempt of physiotherapy should be integrated in a multidisciplinary treatment.

Improving clinical outcomes with lower motor voltage (≤3 V) during stage 1 sacral neuromodulation for interstitial cystitis or bladder pain syndrome.

AIMS: We desire to evaluate whether utilization of ≤3 V (new experimental approach) vs the traditional four or more volts for lead motor response during stage 1 sacral neuromodulation may impart an improvement in voiding and pain parameters. METHODS: An observational, retrospective, double cohort review was conducted of 179 female patients who experienced medically recalcitrant interstitial cystitis (IC) or bladder pain syndrome (BPS) between January 2002 and January 2013. Group A included 105 women with a motor response of ≤3 V; group B was comprised of 65 women with a motor response at ≥4 V for medically recalcitrant IC or BPS. Patients completed a 3-day pre- and postoperative voiding diary, visual analog pain (VAP) scale, pain urgency frequency (PUF), and Patient Global Impression of Improvement (PGI-I) questionnaire. RESULTS: The mean (standard deviation) follow-up in months was 120.1 ± 33.3 in group A and 116.3 ± 29.2 in group B (P < .45). A successful conversion from stage 1 to stage 2 showed statistically significant improvement for group A compared with group B (95.4% vs 73.8% conversion rate; P < .001). The success rate also favored group A, with 87.6% success compared with 66.2% for group B (P < .002). Group A mean postoperative VAP scores improved over group B with 3.3 ± 1.2 compared with 5.0 ± 0.8 (P < .001). Group A mean postoperative PUF scores were 10.2 ± 2.7 and group B 14.7 ± 3.5, (P < .001). CONCLUSIONS: In the ≤3 V patient cohort, a compelling, significant statistical improvement was noted in most clinical voiding parameters, including the VAP, PGI-I, and performance questionnaires.

Temperature-responsive silk-elastinlike protein polymer enhancement of intravesical drug delivery of a therapeutic glycosaminoglycan for treatment of interstitial cystitis/painful bladder syndrome.

Interstitial cystitis (IC), also known as painful bladder syndrome, is a debilitating chronic condition with many patients failing to respond to current treatment options. Rapid clearance, mucosal coating, and tight epithelium create strong natural barriers that reduce the effectiveness of many pharmacological interventions in the bladder. Intravesical drug delivery (IDD) is the administration of therapeutic compounds or devices to the urinary bladder via a urethral catheter. Previous work in improving IDD for IC has focused on the sustained delivery of analgesics within the bladder and other small molecule drugs which do not address underlying inflammation and bladder damage. Therapeutic glycosaminoglycans (GAG) function by restoring the mucosal barrier within the bladder, promoting healing responses, and preventing irritating solutes from reaching the bladder wall. There is an unmet medical need for a therapy that provides both acute relief of symptoms while alleviating underlying physiological sources of inflammation and promoting healing within the urothelium. Semi-synthetic glycosaminoglycan ethers (SAGE) are an emerging class of therapeutic GAG with intrinsic anti-inflammatory and analgesic properties. To reduce SAGE clearance and enhance its accumulation in the bladder, we developed a silk-elastinlike protein polymer (SELP) based system to enhance SAGE IDD. We evaluated in vitro release kinetics, rheological properties, impact on bladder function, pain response, and bladder inflammation and compared their effectiveness to other temperature-responsive polymers including Poloxamer 407 and poly(lactic-co-glycolic acid)-poly(ethylene glycol). SAGE delivered via SELP-enhanced intravesical delivery substantially improved SAGE accumulation in the urothelium, provided a sustained analgesic effect 24 h after administration, and reduced inflammation.

The efficacy of botulinum toxin A and sacral neuromodulation in the management of interstitial cystitis (IC)/bladder pain syndrome (BPS), what do we know? ICI-RS 2017 think thank, Bristol.

AIMS: This manuscript aims to address the evidence availale in the literature on the efficacy of Botulinum Toxin A (BoNT-A) and sacral neuromodulation (SNM) in patients suffering from Interstitial Cystitis (IC)/BPS and propose further research to identify mechanisms of action and establish the clinical efficacy of either therapy. METHODS: At the International Consultation on Incontinence-Research Society (ICI-RS) in 2017, a panel of Functional Urologists and Urogynaecologists participated in a Think Tank (TT) discussing the management of IC/BPS by BoNT-A and SNM, using available data from both PubMed and Medicine literature searches. RESULTS: The role of BoNT-A and SNM in the treatment of IC/BPS are discussed and mechanisms of actions are proposed. Despite the available randomized trial data on the effect of intravesical BoNT-A treatment on symptoms of IC/BPS, a consistent conclusion of a positive effect cannot be drawn at the moment, as the published studies are small and heterogeneous in design. There is substantive evidence for the positive effects of SNM on symptoms of IC/BPS patients however, during patient selection, it is important to distinguish the degree and the location of pain in order to tailor the best therapy to the right patients. CONCLUSIONS: Both intravesical BoNT-A treatment and SNM have been shown to have positive effects in patients with IC/BPS. However, firm conclusions cannot yet be drawn. Patient-reported outcomes and quality of life should be assessed in addition to urinary and pain symptoms. Since current treatments mainly focus on symptomatic relief, future research should also focus on clarifying the pathogenic mechanisms involved in IC/BPS.

Predictors of reoperation after sacral neuromodulation: A single institution evaluation of over 400 patients.

AIMS: To explore factors that may predispose patients to reoperation after sacral neuromodulation (SNM). METHODS: Patients enrolled in our longitudinal neuromodulation database were reviewed. Medical records data, and voiding diaries, Interstitial Cystitis Symptom-Problem Indices (ICSI-PI), and Overactive Bladder Questionnaires (OAB-q) at baseline and 3 months were analyzed with Pearson's χ2 , Fisher's Exact test, Wilcoxon rank tests, and multivariable logistic regression. RESULTS: Of 407 patients, 134 (33%) had at least one reoperation over median 28.9 months follow-up (range 1.6-121.7); 78/407 (19%) were revised, and 56/407 (14%) were explanted. The most common reason for reoperation was lack of efficacy/worsening symptoms (n = 87). The reoperations group had a higher proportion of women (P = 0.049), lower mean body mass index (BMI; P = 0.010), more reprogramming events (P < 0.0001), longer median follow-up (P = 0.0008), and higher proportions with interstitial cystitis (P = 0.013), using hormone replacement therapy (P = 0.0004), and complications (P < 0.0001). Both reoperations/no reoperations groups had similar improvements in ICSI-PI (P < 0.0001 for both), OAB-q severity (P < 0.0001 for both) and quality of life (P < 0.0001 for both). On multivariate analysis, only longer follow-up (P = 0.0011; OR 1.048; CI 1.019, 1.078) and having a complication (P < 0.0001; OR 23.2; CI 11.47, 46.75) were significant predictors of reoperations. In women only, using HRT at time of implant was also predictive of reoperation (P = 0.0027; OR 3.09; CI 1.48, 6.46). CONCLUSIONS: In this largest known series to date, one third of the patients required reoperation and the most common reason was lack of efficacy/worsening symptoms. Ongoing study is needed as the technology continues to evolve. Neurourol. Urodynam. 36:354-359, 2017. © 2015 Wiley Periodicals, Inc.

Evaluation of Percutaneous Tibial Nerve Stimulation for Treatment of Refractory Painful Bladder Syndrome.

OBJECTIVE: To evaluate the efficacy of intermittent percutaneous tibial nerve stimulation (PTNS) as a treatment modality for patients with refractory interstitial cystitis/bladder pain syndrome (IC/BPS). PATIENTS AND METHODS: Twenty female patients with IC/BPS (mean symptom duration of 4.5 ± 2.4 years) each had a 30-minute session of PTNS per week for 12 successive weeks and the symptoms were assessed before, during, and after the treatment sessions by voiding diary, visual analog scale (VAS) for pain, interstitial cystitis symptom and problem indices (ICSI and ICPI), and global response assessment (GRA) scale. The scores of the previous questionnaires were evaluated at weeks 0, 6, and 12. RESULTS: At week 0, the VAS, day time frequency, nocturia, and average voiding volume were 5.6 ± 1.1, 14.5 ± 4.0, 3.0 ± 0.9, and 131.8 ± 35.3 mL, respectively, meanwhile at week 12 these scores were 5.2 ± 1.5, 12.15 ± 3.7, 2.6 ± 0.7, and 141.0 ± 36.2, respectively. There was no statistically significant difference between the scores of the ICPI between weeks 0, 6, and 12 (P = .937). As regards the GRA score after the 12th session, 17 patients (85%) reported having no effect, 1 patient (5%) reported as having worse symptoms, and 2 patients (10%) reported having a mild good response. CONCLUSION: Intermittent PTNS is not a satisfactory treatment for refractory IC/BPS. However, it is recommended to perform more studies with other treatment protocol (maybe closer sessions) to confirm these results.

An endogenous pain control system is altered in subjects with interstitial cystitis.

PURPOSE: Multiple studies have demonstrated that in healthy subjects, painful stimuli applied to one part of the body inhibit pain sensation in other parts of the body, a phenomenon referred to as conditioned pain modulation. Conditioned pain modulation is related to the presence of endogenous pain control systems. Studies have demonstrated deficits in conditioned pain modulation associated inhibition in many but not all chronic pain disorders. In this study we determine whether conditioned pain modulation is altered in subjects with interstitial cystitis/bladder pain syndrome. MATERIALS AND METHODS: Female subjects with and without the diagnosis of interstitial cystitis/bladder pain syndrome were studied psychophysically using quantitative cutaneous thermal, forearm ischemia and ice water immersion tests. Conditioned pain modulation was assessed by quantifying the effects of immersion of the hand in ice water (conditioning stimulus) on threshold and tolerance of cutaneous heat pain (test stimulus) applied to the contralateral lower extremity. RESULTS: The conditioned pain modulation responses of the subjects with interstitial cystitis/bladder pain syndrome were statistically different from those of healthy control subjects for cutaneous thermal threshold and tolerance measures. Healthy control subjects demonstrated statistically significant increases in thermal pain tolerance whereas subjects with the diagnosis of interstitial cystitis/bladder pain syndrome demonstrated statistically significant reductions in thermal pain tolerance. CONCLUSIONS: An endogenous pain inhibitory system normally observed with conditioned pain modulation was altered in subjects with interstitial cystitis/bladder pain syndrome. This finding identifies interstitial cystitis/bladder pain syndrome as similar to several other chronic pain disorders such as fibromyalgia and irritable bowel syndrome, and suggests that a deficit in endogenous pain inhibitory systems may contribute to such chronic pain disorders.

Sacral neuromodulation for refractory overactive bladder, interstitial cystitis, and painful bladder syndrome.

Various pelvic floor conditions, including overactive bladder syndrome and chronic pelvic pain, have been successfully managed with the neuromodulation of sacral nerves. Sacral neuromodulation is a minimally invasive procedure involving the implantation of a programmable pulse generator that delivers low-amplitude electrical current via quadripolar tined leads through the S3 foramen. Durable efficacy has been demonstrated in retrospective studies, but questions regarding ideal patient candidacy and optimal technical considerations remain unanswered.

Painful bladder syndrome and interstitial cystitis: treatment options.

Painful bladder syndrome (PBS) and interstitial cystitis (IC) are associated with bladder pain, increased urinary frequency, urgency and reduced quality of life. The cause is still unknown, although there are several possible hypotheses. PBS/IC may significantly impact all areas of a patient's life as they try to manage their symptoms. Treatment options usually involve diet and fluid modifications, oral medications, intravesical therapy or as a last resort, surgery. The bladder is protected by a mucous layer known as the GAG layer and is thought to protect the underlying urothelium from coming into contact with potassium ions and other irritants contained in urine. Due to research suggesting that sufferers of PBS/IC have dysfunctional GAG layers, there is rationale for intravesical GAG replacement therapy as a treatment option in reducing PBS/IC symptoms such as pain, frequency and urgency. Early diagnosis and treatment may lead to better long-term outcomes.

Maintenance of the response to dimethyl sulfoxide treatment using hyperbaric oxygen in interstitial cystitis/painful bladder syndrome: a prospective, randomized, comparative study.

INTRODUCTION: Interstitial cystitis (IC)/painful bladder syndrome (PBS) is a difficult disease to manage and creates critical limitations in patients' daily lives. Our objective was to determine the efficacy of hyperbaric oxygen (HBO) therapy in the maintenance of response after the administration of intravesical dimethyl sulfoxide (DMSO). MATERIALS AND METHODS: We conducted an open, prospective, randomized, comparative pilot study with women diagnosed with IC/PBS according to the European Society for the Study of Interstitial Cystitis criteria. In the first phase, DMSO was given to all patients. In the second phase, we used 1:1 randomization and administered HBO to 10 women. The evaluated variables were pain (through a visual analog scale), frequency and urgency of voids, nocturia, and quality of life using the O'Leary-Sant Interstitial Cystitis Score/Problem Index and the King's Health Questionnaire. In the second phase, we measured the length of time that clinical improvement was maintained. RESULTS: The mean age was 47.6 years (SD 18.4). Out of 20 patients, 14 experienced clinical improvement after DMSO in all of the evaluated symptoms (p < 0.05; 95% CI). After the second phase, all patients who received HBO had a more substantive and prolonged maintenance of the effects of DMSO. CONCLUSIONS: In this study, HBO improved the maintenance of the beneficial effects of DMSO among women with IC/PBS.

Battery explantation after sacral neuromodulation in the Medicare population.

AIMS: To determine sacral neuromodulation battery life and the patient and provider risk factors for early explantation in a population-based sample. METHODS: A 5% sample of Medicare beneficiaries from 1997 to 2007 served as the data source. All patients who had a sacral neuromodulation device implanted in that time period were included. Variables included in a multivariate analysis of risk factors for removal included gender, age, race, diagnosis, type of test phase, provider specialty, and volume. The number of device reprogramming events was also recorded in this time period. RESULTS: Mean follow-up was 60.5 months. Patients on average had 2.15 reprogramming episodes in their first year, with that number decreasing over subsequent years. Out of the 558 batteries implanted 63 (11.3%) were explanted. Of the 19 implanted individuals who carried the diagnosis of interstitial cystitis (IC), 11 (57.9%) had the battery removed. This was the only variable that predicted early removal, with an odds ratio of explantation of 10.5 (95% CI: 3.9-28.4). CONCLUSION: Very few sacral neuromodulation batteries, once implanted, are removed prematurely. Patients with IC, however, are at very high risk of requiring premature battery removal.

Sacral nerve stimulation during pregnancy: case report and review of the literature.

BACKGROUND: The use of sacral nerve stimulation during pregnancy is not recommended because of the unknown effects on the offspring. There is a paucity of literature on the subject. CASE: A 25-year-old woman who had a sacral nerve stimulator for severe interstitial cystitis/bladder pain syndrome had 2 successful pregnancies. Against medical advice, she kept the stimulator activated for symptom control during the pregnancies. The first child was later diagnosed with chronic motor tic disorder, and the second had a pilonidal sinus at birth. Whether this outcome is related to the neurostimulator is unknown. The efficacy of sacral nerve stimulation decreased after each pregnancy. CONCLUSION: The safety of sacral nerve stimulation in pregnancy has not been well established. Until further research is done, we recommend that women of reproductive age with a sacral nerve stimulator be advised about contraception and that the device should be deactivated before or as soon as pregnancy is confirmed.

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.

Is sensory testing during lead placement crucial for achieving positive outcomes after sacral neuromodulation?

AIMS: Motor and sensory responses help guide lead placement during staged neuromodulation procedures. However, eliciting sensory responses requires lighter anesthesia. We evaluated the impact of assessing sensory responses during quadripolar tined lead placement on outcomes in subjects with refractory voiding symptoms. METHODS: Adults who had a sacral lead placed were identified from our prospective neuromodulation database and grouped by whether they had intraoperative sensory testing or not. History, operative data, and implantable permanent generator (IPG) implant, lead revision and device explant rates were collected from medical records. Symptoms were evaluated with the Interstitial Cystitis Symptom Index/Problem Index (ICSI-PI) and scaled global response assessments (GRA) for the first 24 months post IPG placement. Data were analyzed using Pearson's Chi-square, Fisher's Exact, or Wilcoxon rank test. RESULTS: Of 141 subjects (82% female), 86 (61%) had sensory testing and 55 (39%) did not. Sensory and no sensory testing groups were not significantly different on demographics, urologic diagnosis, IPG implant rates (76/84; 90% and 48/55; 87% respectively) or mean operative time (37.9 ± 13.9 minutes vs. 35.5 ± 11.6). Within 4 years, 19/141 (13.5%) were revised and/or explanted. For explant alone, 11/86 (13%) in the sensory and only 3/55 (5.5%) in the no sensory group (P = 0.16) were explanted. Overall, ICSI-PI scores improved over time (P < 0.0001) and most reported improvement on the GRA at each time point, but no differences were seen between groups. CONCLUSIONS: Intraoperative sensory testing during sacral lead placement does not necessarily improve IPG implantation rates or clinical outcomes of neuromodulation.

Interstitial cystitis/painful bladder syndrome.

Interstitial cystitis/painful bladder syndrome affects more than 1 million persons in the United States, but the cause remains unknown. Most patients with interstitial cystitis/painful bladder syndrome are women with symptoms of suprapubic pelvic and/or genital area pain, dyspareunia, urinary urgency and frequency, and nocturia. It is important to exclude other conditions such as infections. Tests and tools commonly used to diagnose interstitial cystitis/painful bladder syndrome include specific questionnaires developed to assess the condition, the potassium sensitivity test, the anesthetic bladder challenge, and cystoscopy with hydrodistension. Treatment options include oral medications, intravesical instillations, and dietary changes and supplements. Oral medications include pentosan polysulfate sodium, antihistamines, tricyclic antidepressants, and immune modulators. Intravesical medications include dimethyl sulfoxide, pentosan polysulfate sodium, and heparin. Pentosan polysulfate sodium is the only oral therapy and dimethyl sulfoxide is the only intravesical therapy with U.S. Food and Drug Administration approval for the treatment of interstitial cystitis/painful bladder syndrome. To date, clinical trials of individual therapies have been limited in size, quality, and duration of follow-up. Studies of combination or multimodal therapies are lacking.

Efficacy of sacral neuromodulation in treatment of bladder pain syndrome: long-term follow-up.

AIMS: This study was sought to evaluate the efficacy and durability of sacral neuromodulation in the treatment of bladder pain syndrome (BPS) patients. METHODS: A retrospective chart review was performed of patients who had unilateral sacral nerve stimulator (InterStim®) for refractory BPS between June 2002 and December 2004. Patients were qualified for permanent implantation by showing ≥ 50% improvement in their bladder pain and voiding symptoms 1-week post-percutaneous nerve evaluation (PNE). Voiding diary was completed at pre-implantation, 1 year, and on the last visit. Urinary distress inventory short form was completed pre-implantation and on the last visit. Bladder pain was evaluated by visual analogue scale. Primary outcome was improvement in bladder pain. Differences among groups were compared by one-way ANOVA and t-test. Statistical significance was set at P ≤ 0.05. RESULTS: Twenty-one female patients diagnosed with BPS had PNE; 11 patients (52%) showed ≥ 50% improvement in their bladder pain and voiding symptoms and they consider candidates for permanent implantation (Table I), while 10 patients (48%) failed to show 50% improvement in their voiding symptoms or bladder pain (Table II). In those 11 patients who underwent permanent implantation, the average patient's age was 44.3 ± 8.9 years; average time since diagnosis was 3 ± 0.8 years; the average follow- up was 71.5 ± 9.3 months (Table III). There was significant improvement in the bladder pain and voiding parameters at 1-year follow-up, which was maintained at 5-year follow-up. There was continuous improvement in urgency (1.2 ± 0.68) at 1-year follow-up, and (0.98 ± 0.72) at the last visit. Average voided volume was also continuously improved from 242 ± 62.7 ml at 1-year follow-up to 276 ± 64.7 ml on the last visit. CONCLUSION: Sacral neuromodulation as part of multimodal treatment provides an effective long-term treatment option for sub-group of refractory BPS.

The long-term efficacy of sacral neuromodulation in the management of intractable cases of bladder pain syndrome: 14 years of experience in one centre.

UNLABELLED: Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Bladder pain syndrome (BPS) is a chronic debilitating disease. A recently done survey estimates the prevalence of the BPS symptoms among adult females in the U.S. to be 7%. Conservative management is the first line of therapy but at least 10% of the patients show poor response. Sacral neuromodulation is a minimal invasive technique with good long-term outcomes in these patients. It should be considered before any invasive surgical intervention is planned. However, the revision rate is high and patients need lifelong follow-up. OBJECTIVE: • To evaluate the long-term success and tolerability of sacral neuromodulation (SNM) in the control of the symptoms of bladder pain syndrome (BPS). METHODS: • This was a retrospective study of all patients with BPS who underwent peripheral nerve evaluation and then SNM in our department of urology by a single surgeon from 1994 till 2008. The global response assessment scale was used to evaluate the outcome of the SNM. RESULTS: • A total of 78 patients fulfilled the International Consultation on Incontinence clinical criteria for BPS and showed cystoscopic evidence of glomerulation or ulcer as recommended by the European Society for the Study of Interstitial Cystitis/Painful Bladder Syndrome. All patients failed conservative management before considering SNM. • Permanent SNM implant was performed in patients who showed at least 50% improvement in their symptoms with a temporary peripheral nerve evaluation test. Median follow up was 61.5 months (SD ± 27.7). Good long-term success of the SNM was seen in 72% of the patients. • Presence of urgency was a positive predictor of the long-term success of the implant. The explantation rate was 28%. The commonest reason for explantation was poor outcome (54% of the failed patients). The revision rate was 50%. • The most common indication for revision was lack of stimulation sensation and worsening of symptoms. The average durability of the pulse generator battery was 93 months. CONCLUSION: • SNM is an effective treatment to control the symptoms of BPS. It should be considered before any major invasive surgical intervention if conservative measures have failed. It is a minimally invasive, safe procedure with good long-term outcome. However, the revision rate is high and patients require lifelong follow-up.

[Complex local and central therapy of interstitial cystitis with devices AMUS-01-INTRAMAG and AMO-ATOS-E].

A total of 86 females with interstitial cystitis (IC) aged 26-52 years with the disease history over 2.7 years were exposed to intravesical electrostimulation in combination with electromagnetophoresis of heparin-containing mixture of medicines. Relief of pain syndrome and elimination of central hypersensitization were achieved with local procedures on the urinary bladder (UB) alternating (every other day) with procedures of transcranial electrostimulation (TES-therapy, mesodiencephalic modulation). The above treatment proved effective: subjective assessment of pain lowered to "rare" in 60% females, urgency decreased 2-fold, mean effective volume of the bladder increased by 46.2%.