Aspectos psicológicos asociados a la cistitis intersticial / Psychological aspects associated with interstitial cystitis

La cistitis intersticial o síndrome de vejiga dolorosa es un padecimiento complejo asociado a dolor pélvico intenso con síntomas urinarios como urgencia, polaquiuria, dispareunia, incontinencia y nicturia, que afecta de manera importante la calidad de vida y las relaciones sociales y productivas del paciente. La evidencia muestra que el abordaje de los factores psicosociales que afectan a los pacientes con esta enfermedad es esencial. El tratamiento debe ir más allá de los síntomas clínicos y considerar los aspectos individuales de cada paciente, su salud mental, sus experiencias de vida y su comorbilidad, dado que los trastornos psicológicos como la ansiedad, la depresión y el estrés postraumático pueden influir en la manera en que se percibe el dolor, y están ligados con la gravedad y el empeoramiento de los síntomas. La literatura presenta a la intervención psicológica desde el enfoque cognitivo conductual como un medio para disminuir el dolor, la ansiedad y el catastrofismo, dando al paciente herramientas que le permitan obtener una sensación de control a partir del afrontamiento y mejorar su calidad de vida.

Interstitial cystitis or painful bladder syndrome is a complex condition associated with intense pelvic pain with urinary symptoms such as urgency, pollakiuria, dyspareunia, incontinence and nocturia that significantly affects the patient's quality of life, social and productive relationships. Evidence shows that addressing the psychosocial factors that affect patients with this disease is essential. Treatment should go beyond clinical symptoms and consider the individual aspects of each patient, their mental health, life experiences and comorbidities, since psychological disorders such as anxiety, depression and post-traumatic stress disorder can influence the way pain is perceived and are linked to the severity and worsening of symptoms. The literature presents psychological intervention from the cognitive-behavioral approach to reduce pain, anxiety and catastrophism, giving the patient tools that allow him to obtain a sense of control from coping tools that allow him to improve his quality of life.

Intravesical Glycosaminoglycans Experience for Chronic Lower Urinary Tract Pathology Treatment / Experiencia con glucosaminoglicanos intravesicales para el tratamiento de patologías crónicas del tracto urinario inferior

Objective Intravesical glycosaminoglycans (GAG) treatment is one of the therapeutic options for chronic bladder pathologies and is approved for Bladder Pain Syndrome (BPS), radiation cystitis, and recurrent urinary tract infections (UTIs). The purpose of this study is to describe the demographic characteristics of patients with such pathologies in our population and to evaluate treatment response. Methods It is a retrospective study of patients with the aforementioned pathologies, who received treatment with GAG. Demographic characteristics and subjective improvement with treatment were evaluated. A bivariate analysis was performed to study possible improvement predictors. Results 53 patients were evaluated. Of them, 33 (62.3%) with BPS, 12 (22.6%) with recurrent UTIs, and 8 (15.1%) with radiation cystitis. The dose range received was between 4 - 20 instillations, with a median of 6 doses. 67.9% of patients showed improvement of symptoms with treatment, this percentage being even higher for the group of patients with recurrent UTIs (91%). No treatment response predictors were found. Conclusions Intravesical GAG treatment is a therapeutic alternative for patients with chronic bladder pathologies, with satisfactory results in the medium term. Prospective studies are needed to support the findings of this study.

Objetivo El tratamiento con glucosaminoglicanos intravesicales hace parte de las opciones terapéuticas de las patologías crónicas de la vejiga y se encuentra aprobado para el tratamiento de síndrome de vejiga dolorosa (SVD), cistitis por radiación e infección urinaria recurrente. El objetivo de este estudio es describir las características demográficas de los pacientes con dichas patologías en nuestra población y evaluar la respuesta al tratamiento. Métodos Estudio retrospectivo de pacientes con las patologías mencionadas, quienes recibieron tratamiento con glucosaminoglicanos. Se evaluaron las características demográficas y la respuesta al tratamiento. Se realizó un análisis bivariado para estudiar posibles variables predictoras de mejoría. Resultados Se evaluaron 53 pacientes. De estos, 33 (62.3%) con síndrome de vejiga dolorosa, 12 (22.6%) con infección urinaria recurrente y 8 (15.1%) con cistitis por radiación. El rango de dosis recibida estuvo entre 4-20 instilaciones, con una mediana de 6 dosis. El 67.9% de los pacientes tuvo una respuesta adecuada al tratamiento, siendo este porcentaje aún mayor para el grupo de pacientes con IVU recurrente (91%). No se encontraron factores predictores de respuesta al tratamiento. Conclusiones El tratamiento con GAG intravesicales es una alternativa terapéutica para pacientes con patologías crónicas de la vejiga, con resultados satisfactorios a mediano plazo. Se necesitan estudios prospectivos que soporten los hallazgos de este trabajo.

Impact of intravesical hyaluronic acid treatment on bladder inflammation in interstitial cystitis rat model

ABSTRACT Objective: To evaluate the effect of intravesical hyaluronic acid (HA) treatment on inflammatory cells and the severity of inflammation in an interstitial cystitis rat model created with hydrogen chloride (HCL) via immunohistochemical studies and myeloperoxidase activity for the first time in the literature. Materials and Methods: A total of 30 adult female white Rattus Norvegicus rats were divided into 3 groups as the HCL group, hyaluronic acid treatment (HCL-HA) group and control group. Chemical cystitis was created by administering HCL(400 microL,10 mM) except control group. A single dose of intravesical HA(0.5 mL,0.8 mg/mL) was administered to the treatment group. The bladder tissues of all subjects were immunohistochemically stained. The cell surface markers were used to evaluate inflammatory cell infiltration. Mast cell activation and IL-6 was evaluated to assess the inflammation and severity of inflammation, respectively. Myeloperoxidase activity was measured as it shows neutrophil density. Statistical significance was accepted as P<0.05. Results: It was observed that there was rich monocyte, T lymphocyte, B lymphocyte, and Natural Killer cells infiltration and high IL-6 levels in the bladder tissue after the intravesical hydrogen chloride instillation, especially in the stroma layer(p<0.005). In the HCL-HA group, severity of inflammation had statistically significantly regressed to the levels of the control group(p<0.005). An increase was observed in the bladder myeloperoxidase activity of the HCL group compared to the other two groups(p<0.05). Conclusions: Single dose intravesical hyluronic acid instillation reduces inflammatory cell infiltration and the severity of bladder inflammation in the rat model of bladder pain syndrome/interstitial cystitis.

Systematic review of oral therapy for the treatment of symptoms of bladder pain syndrome: The brazilian guidelines / Revisão sistemática sobre terapia oral para tratamento dos sintomas da síndrome da bexiga dolorosa: as diretrizes brasileiras

Abstract Interstitial cystitis (IC), including bladder pain syndrome (BPS), is a chronic and debilitating disease thatmainly affectswomen. It is characterized by pelvic pain associated with urinary urgency, frequency, nocturia and negative urine culture,with normal cytology. In 2009, the Society for Urodynamics and Female Urology (SUFU) defined the term IC/BPS as an unpleasant sensation (pain, pressure, and discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms for more than 6 weeks duration, in the absence of infection or other identifiable causes. This is the definition used by the American Urological Association (AUA) in the most recent guidelines on IC/BPS. Interstitial cystitis may be sufficiently severe to have a devastating effect on the quality of life, but it may also be associated with moderate symptoms whose effects are less debilitating. Although there are several clinical trials to assess oral and intravesical therapies, the treatment for IC remains far from ideal. This systematic assessment evaluates published randomized clinical trials on oralmedications used totreat symptoms of BPS. This studywas performed according to the preferred reporting items for systematic reviews and metaanalyses (PRISMA)method. Two independent reviewers screened the studies to determine their inclusion or exclusion and to perform the methodological analysis. The inclusion criteria included randomized studiespublishedbetween April of 1988and April of2016 that used oral medications to treat symptoms of BPS or IC. According to the systematic review performed,we should consider pentosan polysulfate as one of the bestoptions of oral drugs for the treatment of BPS symptoms. However, this drug is not an available option in Brazil. Orally administered amitriptyline is an efficacious medical treatment for BPS, and it should be the first treatment offered.

Resumo Cistite intersticial (IC), incluindo a síndrome da bexiga dolorosa (SBD), é uma doença crônica e debilitante que afeta principalmente mulheres. É caracterizada por dor pélvica associada à urgência miccional, frequência urinária, noctúria e exame cultural de urina negativo, com citologia normal. A cistite intersticial pode ser suficientemente severa para ter um efeito devastador na qualidade de vida, mas também pode estar associada a sintomas moderados e menos debilitantes. Embora existam vários ensaios clínicos para avaliar terapias orais e intravesicais, o tratamento para IC permanece longe do ideal. Esta revisão sistemática avaliou ensaios clínicos randomizados publicados sobre medicamentos orais usados para tratar sintomas de SBD. Este estudo foi realizado de acordo com ométodo preferred reporting items for systematic reviews and meta-analyses (PRISMA). Dois revisores independentes examinaram os estudos para determinar sua inclusão ou exclusão e para realizar a análise metodológica. Os critérios de inclusão foram: ensaios clínicos randomizados publicados entre abril de 1988 e abril de 2016 que usaram medicações orais no tratamento dos sintomas da SBD ou CI. De acordo com a revisão sistemática realizada, a melhor opção de medicação oral para o tratamento dos SBD é o pentosano polissulfato sódico. No entanto, esta droga não está disponível no Brasil. A amitriptilina administrada por via oral é um tratamento eficaz para SBD e deve ser oferecida como primeira escolha.

Análise das propriedades psicométricas dos instrumentos "The Interstitial Cystitis Symptom Index and Problem Index" e "Pelvic Pain and Urgency/Frequency (PUF) Patient Symptom Scale" e da qualidade de vida de pacientes com cistite intersticial / Analysis of psychometric properties of the instruments "The Interstitial Cystitis Symptom Index and Problem Index" and "Pelvic Pain and Urgency/Frequency (PUF) Patient Symptom Scale" and quality of life of patients with interstitial cystitis

Objetivou-se avaliar a confiabilidade e validade convergente entre os questionários "The Interstitial Cystitis Symptom Index and Problem Index" (The O'Leary-Sant) e "Pelvic Pain and Urgency/Frequency (PUF) Patient Symptom Scale"; verificar quais são as disfunções sexuais em pacientes com CI, identificar suas possíveis causas, verificar os instrumentos de avaliação de qualidade de vida, disfunção sexual e grau da doença e identificar os tratamentos recomendados para esse problema, além de traduzir, adaptar para a cultura brasileira e analisar a confiabilidade e a validade convergente da "Bladder Symptom Impact Scale ¿ BSI-6" utilizada em pacientes com cistite intersticial. Essa tese é composta por dois tipos de estudo: um estudo metodológico de tradução e adaptação cultural, seguindo as etapas metodológicas de tradução, síntese, retrotradução, comitê de especialistas e pré-teste, bem como, análise de confiabilidade de teste-reteste, consistência interna e validade de constructo convergente que envolveu os questionários The O'Leary-Sant, PUF e BSI-6. O segundo tipo de estudo foi uma revisão integrativa da literatura que incluiu 19 publicações relacionadas a disfunção sexual em mulheres com cistite intersticial, mediante pesquisa realizada nas bases de dados: PubMed, Embase, CINAHL e PEDro. As fases de tradução, síntese das traduções e retrotradução da Bladder Symptom Impact Scale ¿ BSI-6, que avalia a qualidade de vida em pessoas com cistite intersticial, foram finalizadas satisfatoriamente e a avaliação das versões síntese pelo comitê de especialistas resultou em algumas alterações, assegurando as equivalências entre a versão original e traduzida. Devido à necessidade de modificações em decorrência da baixa escolaridade da população, o instrumento foi pré-testado duas vezes no total de 35 sujeitos com sintomas de cistite intersticial. O instrumento, após as alterações, demonstrou ser de fácil compreensão e rápido preenchimento. A confiabilidade foi avaliada por meio da consistência interna medida pelo alfa de Cronbach, com resultado geral de: 0,92 e a validade de constructo convergente foi medida por meio da correlação com o The O'Leary-Sant e medida pelo coeficiente de correlação de Spearman e se mostrou alta. A confiabilidade de teste-reteste para os questionários "The O'Leary-Sant" e "PUF" apresentou valores superiores a 0,80, sugerindo excelente confiabilidade. A consistência interna se mostrou boa para ambos, apresentando valores superiores a 0,70. A correlação entre os dois questionários expressa pelo coeficiente de correlação de Spearman se mostrou elevada. Os estudos analisados na revisão integrativa da literatura apontaram a dispareunia e vulvodinia como os principais problemas sexuais de mulheres com CI. As principais causas desses problemas são hipertonia da musculatura do assoalho pélvico e história prévia de abuso sexual. Concluiu-se que, os questionários "The Interstitial Cystitis Symptom Index and Problem Index" e "Pelvic Pain and Urgency/Frequency (PUF) Patient Symptom Scale" se mostraram confiáveis e válidos para serem aplicados em pacientes com CI, auxiliando o seu diagnóstico; que a aplicação de uma meticulosa metodologia permitiu a produção de uma versão da Bladder Symptom Impact Scale ¿ BSI-6, em português, fiel à original, confiável e válida que poderá ser utilizada para a avaliar a qualidade de vida de pessoas com cistite intersticial e, por fim, os estudos mostram que mulheres com CI e que possuem disfunção sexual devem ser tratadas por uma equipe multiprofissional a fim de melhorar os sintomas da doença e, consequentemente, a qualidade de vida, assim sendo, os instrumentos para diagnóstico e avaliação da qualidade de vida traduzidos e validados poderão ser úteis para esse fim. (AU)

This study aimed to assess the reliability and convergent validity of the questionnaires "The Interstitial Cystitis Symptom Index and Problem Index" (The O'Leary-Sant) and "Pelvic Pain and Urgency / Frequency (PUF) Patient Symptom Scale"; check what are the sexual dysfunctions in patients with IC, identify possible causes, check the instruments for assessing quality of life, sexual dysfunction and degree of the disease and identify the recommended treatments for this problem, as well as to translate, adapt to the Brazilian culture and analyze the reliability and convergent validity of the "Bladder Symptom Impact Scale - BSI-6" used in patients with interstitial cystitis. This thesis is composed of two types of studies: a methodological study of translation and cultural adaptation, following the methodological steps of translation, synthesis, back translation, expert committee and pre-test and test-retest reliability analysis, consistency internal and convergent construct validity involving the questionnaires The O'Leary-Sant, PUF and BSI-6. The second type of study is an integrative literature review that included 19 publications related to sexual dysfunction in women with interstitial cystitis, by research conducted in the databases PubMed, Embase, CINAHL and PEDro. The phases of translation, synthesis of translations and back translation of Bladder Symptom Impact Scale - BSI-6, which evaluates the quality of life in people with interstitial cystitis, were completed satisfactorily and the evaluation of versions synthesis by the expert committee resulted in some changes, ensuring the equivalence between the original and translated version. Due to the need for changes due to the low educational level of the population, the instrument was pre-tested twice in the total of 35 subjects with symptoms of interstitial cystitis. The instrument, after the changes proved to be easy to understand and quick filling. Reliability was assessed by internal consistency measured by Cronbach's alpha, with the overall result of: 0.92 and convergent construct validity was measured by correlating with The O'Leary-Sant and measured by the correlation coefficient Spearman and showed high. The test-retest reliability for the questionnaire "The O'Leary-Sant" and "PUF" presented values greater than 0.80, suggesting excellent reliability. The internal consistency proved to be good for both, with values above 0.70. The correlation between the two questionnaires expressed by the Spearman correlation coefficient showed high. The studies that analyzed the integrative literature review showed dyspareunia and vulvodynia as the main sexual problems in women with IC. The main causes of these problems are hypertonia of the pelvic floor muscles and a history of sexual abuse. It was concluded that questionnaires "The Interstitial Cystitis Symptom Index and Problem Index" and "Pelvic Pain and Urgency / Frequency (PUF) Patient Symptom Scale" proved to be reliable and valid to be used in patients with IC, supporting the diagnosis; that the application of a meticulous methodology enabled the production of a version of the Bladder Symptom Impact Scale - BSI-6 in Portuguese, faithful to the original, and proved to be reliable and valid and can be used to assess the quality of life of people with interstitial cystitis and finally, studies show that women who have sexual dysfunction should be treated by a multidisciplinary team in order to ameliorate the symptoms of the disease and, consequently, the quality of life, therefore, the tools for diagnosis and assessment of quality of life translated and validated may be useful for this purpose.(AU)

Urinary proteomics evaluation in interstitial cystitis/painful bladder syndrome: a pilot study

PURPOSE: Interstitial cystitis/painful bladder syndrome (IC/PBS) is characterized by chronic pain, pressure and discomfort felt in the pelvis or bladder. An in-depth shotgun proteomics study was carried out to profile the urinary proteome of women with IC/PBS to identify possible specific proteins and networks associated with IC/PBS. MATERIALS AND METHODS: Urine samples from ten female IC/PBS patients and ten female asymptomatic, healthy control subjects were analyzed in quadruplicate by liquid chromatography-tandem mass spectrometry (LC-MS/MS) on a hybrid linear ion trap-orbitrap mass spectrometer. Gas-phase fractionation (GPF) was used to enhance protein identification. Differences in protein quantity were determined by peptide spectral counting. RESULTS: a-1B-glycoprotein (A1BG) and orosomucoid-1 (ORM1) were detected in all IC/PBS patients, and = 60 percent of these patients had elevated expression of these two proteins compared to control subjects. Transthyretin (TTR) and hemopexin (HPX) were detected in all control individuals, but = 60 percent of the IC/PBS patients had decreased expression levels of these two proteins. Enrichment functional analysis showed cell adhesion and response to stimuli were down-regulated whereas response to inflammation, wounding, and tissue degradation were up-regulated in IC/PBS. Activation of neurophysiological processes in synaptic inhibition, and lack of DNA damage repair may also be key components of IC/PBS. CONCLUSION: There are qualitative and quantitative differences between the urinary proteomes of women with and without IC/PBS. We identified a number of proteins as well as pathways/networks that might contribute to the pathology of IC/PBS or result from perturbations induced by this condition.

Fisioterapia na cistite intersticial / Physical therapy on interstitial cystitis

Cistite intersticial (CI) é uma síndrome de etiologia desconhecida, multifatorial, que provoca sintomas no trato urinário inferior como aumento na frequência urinária, urgência miccional, noctúria, acompanhada de dor vesical que frequentemente é aliviada após a micção. A prevalência é maior nas mulheres, que podem apresentar dor em região suprapúbica, perineal, vaginal e, não raramente, dispareunia. A conduta terapêutica é difícil, pela baixa eficácia nos tratamentos oferecidos e pelo alto impacto da doença na qualidade de vida dos pacientes. A fisioterapia surge como um tratamento promissor e de papel fundamental na melhora sintomatológica e redução da disfunção do assoalho pélvico, que comumente acometem os portadores dessa síndrome. Apesar da escassez de trabalhos científicos, principalmente no Brasil, utilizando apenas técnicas fisioterapêuticas, esta revisão discutiu o papel da fisioterapia na CI, enfatizando a terapia manual para o assoalho pélvico (massagem de Thiele) e a terapia comportamental como técnicas mais empregadas para alívio dos sintomas e melhoria na qualidade de vida dos pacientes

Interstitial cystitis (IC) is a mulfactorial syndrome with unknown etiology, which causes symptoms on the lower urinary tract characterized by urinary frequency, urgency, nocturia and bladder pain that diminishes with bladder emptying. The prevalence is significantly higher in women who may have suprapubic, vaginal, perineal pains and dyspareunia. The therapeutic is difficult due to the lower efficiency of the treatments offered and the higher impact in the quality of patients' life. The physical therapy appears tobe a promising treatment and has a fundamental part on the symptoms improvement and reduction of pelvic floor dysfunction. In spite of the shortage of scientific articles using only physiotherapeutic techniques, mainly in Brazil, this review discussed the role of physical therapy on the IC, mainly manual therapy of pelvic floor (Thiele massage) and behavior therapy to relieve the symptoms and improve the quality of life