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Canadian Urological Association Journal... Jan 2018We sought to determine if patients' perceptions of success or failure of interstitial cystitis/bladder pain syndrome (IC/BPS) therapies proposed in treatment guidelines...
INTRODUCTION
We sought to determine if patients' perceptions of success or failure of interstitial cystitis/bladder pain syndrome (IC/BPS) therapies proposed in treatment guidelines align with the evidence from available clinical trial treatment data.
METHODS
A total of 1628 adult females with a self-reported diagnosis of IC completed a web-based survey in which patients described their perceived outcomes with the therapies they were exposed to. Previously published literature, used in part to develop IC/BPS guidelines, provided the clinical trial data outcomes. Patient-reported outcomes were compared to available clinical trial outcomes and published treatment guidelines.
RESULTS
Based on patient perceived outcomes (benefit:risk ratio), the most effective treatments were opioids, phenazopyridine, and alkalizing agents, with amitriptyline and antihistamines reported as moderately effective. The only surgical procedure with any effectiveness was electrocautery of Hunner's lesions. In order of efficacy reported in the literature, the therapies for IC/BPS with predicted superior outcomes should be: cyclosporine A, amitriptyline, hyperbaric oxygen, pentosan polysulfate plus subcutaneous heparin, botulinum toxin A plus hydrodistension, and L-arginine. While some of the guideline recommendations aligned with patient-reported effectiveness data, there was a general disconnect between guidelines and effectiveness reported in clinical practice.
CONCLUSIONS
There is a disconnect between real-world patient perceived effectiveness of IC/BPS treatments compared to the efficacy reported from clinical trial data and subsequent guidelines developed from this efficacy data. Optimal therapy must include the best evidence from clinical research, but should also include real-life clinical practice implementation and effectiveness.
PubMed: 29173267
DOI: 10.5489/cuaj.4505 -
The American Journal of Emergency... Oct 2014Drug-induced methemoglobinemia is a well-described entity but has not been previously associated with elevated troponins in the absence of cardiac symptoms. We report a...
Drug-induced methemoglobinemia is a well-described entity but has not been previously associated with elevated troponins in the absence of cardiac symptoms. We report a case of a patient presenting to the emergency department (ED) with complaints related to an exacerbation of her long-standing cystitis. A low pulse oximetry reading prompted an evaluation, revealing a troponin leak, which peaked at 10 hours. Her methemoglobin level was found to be elevated at 11.4%, but a preexisting anemia apparently prevented the clinical recognition of cyanosis. The methemoglobinemia was determined to be secondary to her ingestion of phenazopyridine and trimethoprim-sulfa methoxizole. Although phenazopyridine and sulfa agents have long been known to cause methemoglobinemia, our patient exhibited an asymptomatic troponin leak that has not been previously reported as a complication of drug-induced methemoglobinemia. Clinicians should be aware of this potential association.
Topics: Anesthetics, Local; Anti-Infective Agents, Urinary; Cystitis, Interstitial; Female; Humans; Methemoglobinemia; Middle Aged; Myocardial Ischemia; Phenazopyridine; Trimethoprim, Sulfamethoxazole Drug Combination; Troponin I
PubMed: 24686024
DOI: 10.1016/j.ajem.2014.03.015 -
Disease-a-month : DM Jun 2017
Topics: Administration, Intravaginal; Adult; Aged; Anti-Bacterial Agents; Body Piercing; Campylobacter Infections; Campylobacter jejuni; Cellulitis; Ciprofloxacin; Communicable Diseases; Cyanosis; Diarrhea; Dietary Fiber; Drug Therapy, Combination; Estrogens; Female; Helicobacter Infections; Humans; Lyme Disease; Male; Metronidazole; Middle Aged; Otitis; Penicillin V; Phenazopyridine; Proton Pump Inhibitors; Tetracycline; Tick Bites; Travel-Related Illness; Urinary Tract Infections; Young Adult
PubMed: 28651688
DOI: 10.1016/j.disamonth.2017.03.011 -
Female Pelvic Medicine & Reconstructive... 2017This study aimed to compare the effect of periurethral infiltration of bupivacaine versus normal saline on postoperative voiding function and pain in patients undergoing... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
This study aimed to compare the effect of periurethral infiltration of bupivacaine versus normal saline on postoperative voiding function and pain in patients undergoing retropubic midurethral sling METHODS: A randomized double-blind placebo-controlled study was performed at the University of Massachusetts from March 2012 to June 2015. Ninety patients were randomized to receive 0.5% bupivacaine with epinephrine or normal saline with epinephrine solution for periurethral hydrodissection. Postoperative pain was assessed at 2 to 3 and 6 to 7 hours using a visual analog scale. Voiding function was determined by the proportion of subjects passing or failing a voiding trial. Descriptive statistics and percentages were used to compare the rate of voiding dysfunction. A logistic regression analysis was performed adjusting for possible covariates.
RESULTS
Ninety subjects enrolled and 45 were randomized to each group. Thirty-nine subjects received the normal saline and 41 received bupivacaine. The remaining 10 withdrew before the procedure. Pain scores at 2 to 3 hours did not differ between the groups (P = 0.837), but at 6 to 7 hours, patients who received bupivacaine had less pain (P = 0.028). There was no difference in voiding dysfunction between the study and placebo groups (17.9% and 24.4%, respectively; P = 0.481). Because of the unavailability of indigo carmine midway through the study, 36 of 80 subjects received preoperative phenazopyridine for the assessment of ureteral patency. Three (8%) of these subjects failed their voiding trial compared with 19 (30%) of the patients who did not receive phenazopyridine (P = 0.010).
CONCLUSIONS
The use of bupivacaine did not affect postoperative voiding function but had lower pain scores at 6 to 7 hours postoperatively. Preoperative phenazopyridine may reduce postoperative urinary retention.
Topics: Adult; Anesthetics, Local; Bupivacaine; Double-Blind Method; Female; Humans; Pain Measurement; Pain, Postoperative; Suburethral Slings; Time Factors; Urination
PubMed: 27682748
DOI: 10.1097/SPV.0000000000000343 -
Analytical Chemistry Jul 2018A design of electromembrane extraction (EME) as a lab on-a-chip device was proposed for the extraction and determination of phenazopyridine as the model analyte. The...
A design of electromembrane extraction (EME) as a lab on-a-chip device was proposed for the extraction and determination of phenazopyridine as the model analyte. The extraction procedure was accomplished by coupling EME and packing a sorbent. The analyte was extracted under the applied electrical field across a membrane sheet impregnated by nitrophenyl octylether (NPOE) into an acceptor phase. It was followed by the absorption of the analyte on strong cation exchanger as a sorbent. The designed chip contained separate spiral channels for donor and acceptor phases featuring embedded platinum electrodes to enhance extraction efficiency. The selected donor and acceptor phases were 0 mM HCl and 100 mM HCl, respectively. The on-chip electromembrane extraction was carried out under the voltage level of 70 V for 50 min. The analysis was carried out by two modes of a simple red-green-blue (RGB) image analysis tool and a conventional HPLC-UV system. After the absorption of the analyte on the solid phase, its color changed and a digital picture of the sorbent was taken for the RGB analysis. The effective parameters on the performance of the chip device, comprising the EME and solid phase microextraction steps, were distinguished and optimized. The accumulation of the analyte on the solid phase showed excellent sensitivity and a limit of detection (LOD) lower than 1.0 μg L achieved by an image analysis using a smartphone. This device also offered acceptable intra- and interassay RSD% (<10%). The calibration curves were linear within the range of 10-1000 μg L and 30-1000 μg L ( r > 0.9969) for HPLC-UV and RGB analysis, respectively. To investigate the applicability of the method in complicated matrixes, urine samples of patients being treated with phenazopyridine were analyzed.
Topics: Adult; Cation Exchange Resins; Chromatography, High Pressure Liquid; Electricity; Electrochemical Techniques; Electrodes; Equipment Design; Female; Humans; Lab-On-A-Chip Devices; Membranes, Artificial; Phenazopyridine; Solid Phase Microextraction; Spectrophotometry, Ultraviolet; Young Adult
PubMed: 29847097
DOI: 10.1021/acs.analchem.8b01224 -
Materials Science & Engineering. C,... Apr 2016Computational study has been done electronically and geometrically to select the most suitable ionophore to design a novel sensitive and selective electrochemical sensor...
Computational study has been done electronically and geometrically to select the most suitable ionophore to design a novel sensitive and selective electrochemical sensor for phenazopyridine hydrochloride (PAP). This study has revealed that sodium tetraphenylbarate (NaTPB) fits better with PAP than potassium tetrakis (KTClPB). The sensor design is based on the ion pair of PAP with NaTPB using dioctyl phthalate as a plasticizer. Under optimum conditions, the proposed sensor shows the slope of 59.5 mV per concentration decade in the concentration range of 1.0 × 10(-2)-1.0 × 10(-5) M with detection limit 8.5 × 10(-6) M. The sensor exhibits a very good selectivity for PAP with respect to a large number of interfering species as inorganic cations and sugars. The sensor enables track of determining PAP in the presence of its oxidative degradation product 2, 3, 6-Triaminopyridine, which is also its toxic metabolite. The proposed sensor has been successfully applied for the selective determination of PAP in pharmaceutical formulation. Also, the obtained results have been statistically compared to a reported electrochemical method indicating no significant difference between the investigated method and the reported one with respect to accuracy and precision.
Topics: Carbohydrates; Cations; Electrochemical Techniques; Electrodes; Hydrogen-Ion Concentration; Inorganic Chemicals; Ion Exchange; Phenazopyridine; Plasticizers; Research Design; Tablets; Temperature
PubMed: 26838908
DOI: 10.1016/j.msec.2016.01.016 -
Female Pelvic Medicine & Reconstructive... 2018To determine the effect of preoperative oral phenazopyridine on postoperative voiding dysfunction in women undergoing a retropubic midurethral sling. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To determine the effect of preoperative oral phenazopyridine on postoperative voiding dysfunction in women undergoing a retropubic midurethral sling.
METHODS
A single-institution randomized clinical trial was performed from September 2015 to March 2017, comparing 200 mg of oral phenazopyridine versus no phenazopyridine in patients undergoing a retropubic midurethral sling under general anesthesia with no concomitant procedures. A power calculation indicated that we required at least 40 subjects per arm. Preoperative demographics, intraoperative medications, blood loss, and complications were recorded. A standardized voiding trial was performed before discharge. Voiding dysfunction was determined by the proportion of subjects who failed a postoperative voiding trial. Pain scores were obtained before and 2 to 3 hours after the surgical procedure. Patient characteristics and surgical data were compared using χ, Fisher exact test, or Wilcoxon rank sum test.
RESULTS
Ninety-two subjects were enrolled in the study. Three patients cancelled their surgery and 1 had an intraoperative urethral injury, leaving 88 patients for the final analysis (44 per arm). Patient demographics showed no differences between groups. Phenazopyridine did not reduce the proportion of patients who failed the voiding trial (27%) compared with subjects who did not receive the medication (21%) (P = 0.453). Postoperative visual analog pain scores were higher in those not receiving phenazopyridine (1.76 vs 1.21, P = 0.046), but after adjusting for the difference in preoperative and postoperative pain scores, the groups showed no difference (P = 0.087).
CONCLUSIONS
Our prospective trial shows that phenazopyridine has no effect on short-term postoperative voiding dysfunction. This condition appears to be multifactorial, and further research is needed.
Topics: Administration, Oral; Anesthesia, General; Anesthetics, Local; Body Mass Index; Female; Humans; Middle Aged; Phenazopyridine; Postoperative Complications; Preoperative Care; Prospective Studies; Suburethral Slings; Treatment Outcome; Urinary Incontinence, Stress; Urinary Retention
PubMed: 29474280
DOI: 10.1097/SPV.0000000000000497 -
Clinics and Practice Oct 2022Methemoglobinemia is a rare blood disorder characterized by the oxidation of heme iron from ferrous (Fe) to ferric (Fe) state, which increases oxygen affinity and...
Methemoglobinemia is a rare blood disorder characterized by the oxidation of heme iron from ferrous (Fe) to ferric (Fe) state, which increases oxygen affinity and impairs oxygen release to the tissue causing hypoxia. It can be congenital or acquired; however, most cases are acquired and caused by exogenous substances such as medications, chemicals, and environmental substances. Phenazopyridine is an over-the-counter urinary analgesic medication commonly used for symptomatic relief of dysuria and has been reported to cause methemoglobinemia. However, only a handful of cases of phenazopyridine-induced methemoglobinemia have been reported. We present a case of an 89-year-old female who presented with severe hypoxia, shortness of breath, headache, nausea, and dizziness caused by phenazopyridine-induced methemoglobinemia. She was found to have a methemoglobin level of 21.5% and was treated with methylene blue, leading to a rapid improvement of her symptoms. She was taking one over-the-counter phenazopyridine 200 mg tablet three times daily for two weeks for her chronic dysuria. This case highlights the need to have a high index of suspicion of phenazopyridine-induced methemoglobinemia in a patient presenting with unexplained shortness of breath with a history of phenazopyridine use as it could lead to severe methemoglobinemia with hypoxia that could potentially be fatal if not promptly diagnosed.
PubMed: 36412668
DOI: 10.3390/clinpract12060089 -
The Canadian Journal of Urology Jun 2024Drug-induced nephrolithiasis represents only 1%-2% of stone cases. Here we focus on drugs capable of crystallizing and forming stone, specifically phenazopyridine...
Drug-induced nephrolithiasis represents only 1%-2% of stone cases. Here we focus on drugs capable of crystallizing and forming stone, specifically phenazopyridine (Pyridium/Azo). This is a case of a patient who presented with a stone conglomerate in the right proximal ureter and underwent definitive treatment. Interestingly, the stone had a purple hue with FTIR spectroscopy showing stone composition of calcium oxalate (monohydrate and dihydrate) and a material resembling phenazopyridine. We retrospectively learned that she used multiple extended courses of phenazopyridine over 3 months.
Topics: Humans; Phenazopyridine; Female; Kidney Calculi; Middle Aged
PubMed: 38912947
DOI: No ID Found -
Journal of Chromatographic Science 2016In this study, two analytical approaches were exploited for the resolution of binary mixtures of ciprofloxacin HCl (CIP) or norfloxacin (NOR) and phenazopyridine HCl...
Derivative Quotient Spectrophotometry and an Eco-Friendly Micellar Chromatographic Approach with Time-Programmed UV-Detection for the Separation of Two Fluoroquinolones and Phenazopyridine.
In this study, two analytical approaches were exploited for the resolution of binary mixtures of ciprofloxacin HCl (CIP) or norfloxacin (NOR) and phenazopyridine HCl (PHZ). In the first approach, the amplitudes of the first derivative of the ratio spectra were measured at 267 or 287 nm for CIP and at 268 or 291 nm for NOR. PHZ could be directly determined in the presence of CIP or NOR at 405 nm. The calibration graphs were rectilinear over the ranges of 1.0-16.0 µg/mL for CIP or NOR and 1.0-10.0 µg/mL for PHZ. In the second approach, an accurate, reliable and environmentally nontoxic micellar liquid chromatographic (MLC) method was developed. A good chromatographic separation was achieved using a 150 mm × 4.6 mm i.d., 5 µm particle size Spherisorb ODS-2 column. Eco-friendly mobile phase containing 0.12 M sodium dodecyl sulphate, 0.3% triethylamine and 6%n-butanol in 0.02 M orthophosphoric acid of pH 3.0 was pumped at a flow rate of 1 mL/min. Time programmed UV-detection was applied to allow sensitive determination of the studied drugs. The analytes were eluted without interferences in <10 min. Methocarbamol was used as an internal standard. The MLC method was found to be rectilinear over the concentration range of 0.5-20.0 μg/mL for CIP, NOR or PHZ. These optimized and validated methods were successfully applied for the simultaneous analysis of the studied drugs in their synthetic mixtures and co-formulated tablets. Moreover, the second method was further extended to the determination of these drugs in human urine with direct injection and without any pretreatment.
Topics: Chromatography, High Pressure Liquid; Fluoroquinolones; Micelles; Phenazopyridine; Spectrophotometry, Ultraviolet
PubMed: 26867555
DOI: 10.1093/chromsci/bmw010