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Urologie (Heidelberg, Germany) Jun 2023In this review, aspects of interstitial cystitis/bladder pain syndrome (IC/BPS) are presented against the background of the German S2k guideline on this disease. (Review)
Review
BACKGROUND
In this review, aspects of interstitial cystitis/bladder pain syndrome (IC/BPS) are presented against the background of the German S2k guideline on this disease.
OBJECTIVE
Quite often this disease, characterized by bladder or lower abdominal pain (permanent or intermittent) and pollakisuria without pathogenic bacteria in the urine culture, is diagnosed much too late.
MATERIALS AND METHODS
The debate on disease definition, aspects on pathophysiology and epidemiology are presented. For diagnosis, disease severity must be determined and relevant differential diagnoses like bladder cancer must be excluded. Conservative measures (clothing, food, sexuality, sport, bladder training, sufficient fluid intake, prevention of hypothermia) are effective especially in early stages of the disease. Combination drug therapy with mucosa stabilizing, anti-inflammatory, psychotropic, and pain-reducing drugs should be adjusted individually. Inpatient rehabilitation, hydrodistension, laser- and electrocoagulation, neuromodulation (sacral or pudendal) or hyperbaric oxygen therapy may help after pharmacotherapy failure. Cystectomy and urinary diversion are used in irreversible shrunken urinary bladder.
RESULTS
If all treatment modalities are consequently used, many patients may reach a state that is more bearable.
CONCLUSION
With a high level of suffering in many patients with IC/BPS, all available treatment modalities should be known and used.
Topics: Humans; Cystitis, Interstitial; Urinary Bladder; Urinary Bladder Neoplasms; Cystectomy; Urinary Diversion
PubMed: 37115301
DOI: 10.1007/s00120-023-02080-x -
Geriatrics & Gerontology International Apr 2019The prevalence of constipation and prevalence of pollakisuria among older patients receiving home medical care have not been reported, and risk factors for these... (Observational Study)
Observational Study
AIM
The prevalence of constipation and prevalence of pollakisuria among older patients receiving home medical care have not been reported, and risk factors for these symptoms are not clear in this setting. The present study sought to determine the prevalence and risk factors of constipation and pollakisuria among older patients receiving home medical care in Japan.
METHODS
This study utilized data from patients in the Observational Study of Nagoya Elderly with Home Medical Care (n = 153). We carried out univariate and multivariate logistic regression analyses with the presence of constipation or pollakisuria as the dependent variable to evaluate the relationships between constipation or pollakisuria and several covariates.
RESULTS
The prevalence of constipation and pollakisuria were 56.9% and 15.7%, respectively. Multivariate logistic analysis showed that constipation was associated with Charlson Comorbidity Index score, polypharmacy and pollakisuria, and pollakisuria was associated with constipation and insomnia. Cardiovascular disease was inversely associated with constipation.
CONCLUSIONS
The prevalence of constipation among home-care patients was as high as that reported for nursing home residents and higher than that among community-dwelling individuals. Clinicians should be aware of increased constipation risk among home-care patients, particularly for those with a high Carlson Comorbidity Index score, polypharmacy and/or pollakisuria. Geriatr Gerontol Int 2019; 19: 277-281.
Topics: Aged; Constipation; Female; Home Care Services; Humans; Hypnotics and Sedatives; Independent Living; Japan; Laxatives; Male; Prevalence; Risk Factors; Sleep Initiation and Maintenance Disorders; Urination Disorders
PubMed: 30628140
DOI: 10.1111/ggi.13610 -
World Journal of Gastroenterology Nov 2014IgG4-related autoimmune pancreatitis is frequently accompanied by relevant lesions in the genitourinary tract and retroperitoneal organs, which cause various clinical... (Review)
Review
IgG4-related autoimmune pancreatitis is frequently accompanied by relevant lesions in the genitourinary tract and retroperitoneal organs, which cause various clinical problems, ranging from non-specific back pain or bladder outlet obstruction to renal failure. The diagnosis of IgG4-related retroperitoneal fibrosis requires a multidisciplinary approach, including serological tests, histological examination, imaging analysis, and susceptibility to steroid therapy. Radiological examinations are helpful to diagnose this condition, but surgical resection is occasionally unavoidable to exclude malignancy, particularly for patients with isolated retroperitoneal involvement. Steroid therapy is the treatment of choice for this condition, the same as for other manifestations of IgG4-related disease. For patients with severe ureteral obstruction, additional ureteral stenting needs to be considered prior to steroid therapy to preserve the renal function. Some papers have suggested that IgG4-related disease can affect male reproductive organs including the prostate and testis. IgG4-related prostatitis usually causes lower urinary tract symptoms, such as dysuria and pollakisuria. Patients sometimes state that corticosteroids given for IgG4-related disease at other sites relieve their lower urinary tract symptoms, which leads us to suspect prostatic involvement in this condition. Because of the limited number of publications available, further studies are warranted to better characterize IgG4-related disease in male reproductive organs.
Topics: Adrenal Cortex Hormones; Animals; Autoimmune Diseases; Biomarkers; Diagnostic Imaging; Female Urogenital Diseases; Humans; Immunoglobulin G; Male; Male Urogenital Diseases; Pancreatitis; Predictive Value of Tests; Retroperitoneal Fibrosis; Risk Factors; Sex Factors; Stents; Treatment Outcome
PubMed: 25469023
DOI: 10.3748/wjg.v20.i44.16550 -
Pediatric Nephrology (Berlin, Germany) Apr 2022
Topics: Cystitis; Dysuria; Eosinophilia; Humans; Polyuria
PubMed: 34796393
DOI: 10.1007/s00467-021-05128-2 -
Anticancer Research Aug 2023The aim of the present study was to investigate the factors related to overactive bladder (OAB)-like symptoms in patients with bladder cancer.
BACKGROUND/AIM
The aim of the present study was to investigate the factors related to overactive bladder (OAB)-like symptoms in patients with bladder cancer.
PATIENTS AND METHODS
This study included 59 patients who underwent transurethral resection of bladder tumor (TURBT). OAB-like symptoms were identified based on the Overactive Bladder Symptom Score (OABSS) and International Prostate Symptom Score (IPSS) questionnaires. The main outcome measures were elucidation of bladder cancer-related factors that might induce OAB-like symptoms.
RESULTS
Non-muscle invasive bladder cancer (NMIBC) was observed in 50 patients, and carcinoma in situ (CIS) was observed in 14 patients. OABSS total score, IPSS total score, and quality of life index were 5±3, 12±7 and 3±1, respectively. The OABSS question 1 score, indicating pollakisuria, was significantly higher in NMIBC patients with CIS than in those without CIS (presence of CIS vs. absence of CIS=1.0±0.6 : 0.5±0.6, p=0.02). IPSS question 4 score, indicating urgency (r=0.31, p=0.01), and OABSS question 4 score, indicating urgency incontinence (r=0.29, p=0.03), correlated significantly with the maximum bladder tumor diameter. Multivariate regression analysis demonstrated that presence of CIS in NMIBC cases correlated significantly with pollakisuria (p=0.02), and that maximum diameter of the bladder tumor correlated significantly with both urgency (p=0.04) and urgency incontinence (p=0.01).
CONCLUSION
CIS induced pollakisuria in NMIBC. Larger diameter bladder tumors induced both urgency and urgency incontinence. Patients with bladder cancer who present with pollakisuria might have CIS.
Topics: Male; Humans; Urinary Bladder, Overactive; Quality of Life; Urinary Bladder; Urinary Incontinence; Urinary Bladder Neoplasms
PubMed: 37500156
DOI: 10.21873/anticanres.16540 -
Pediatric Nephrology (Berlin, Germany) Apr 2022
Topics: Cystitis; Dysuria; Eosinophilia; Humans; Polyuria
PubMed: 34796394
DOI: 10.1007/s00467-021-05130-8 -
Endocrinology, Diabetes & Metabolism... Mar 2021Apart from adrenal myelolipomas, adrenal lipomatous tumors are rare and only seldom described in the literature. We present the case of a 50-year-old man, with a...
SUMMARY
Apart from adrenal myelolipomas, adrenal lipomatous tumors are rare and only seldom described in the literature. We present the case of a 50-year-old man, with a classical form of congenital adrenal hyperplasia (CAH), which was well treated with prednisolone and fludrocortisone. The patient presented with pollakisuria and shortness of breath while bending over. On MRI, fat-equivalent masses were found in the abdomen (14 × 19 × 11 cm on the right side and 10 × 11 × 6 cm on the left side). The right adrenal mass was resected during open laparotomy and the pathohistological examination revealed the diagnosis of an adrenal lipoma. Symptoms were subdued totally postoperatively. This is the first report of a bilateral adrenal lipoma in a patient with CAH that we are aware of.
LEARNING POINTS
Macronodular hyperplasia is common in patients with congenital adrenal hyperplasia (CAH). Solitary adrenal tumors appear in approximately 10% of adult CAH patients and are often benign myelolipomas. The Endocrine Society Clinical Practice Guideline does not recommend routine adrenal imaging in adult CAH patients. Adrenal imaging should be performed in CAH patients with clinical signs for an adrenal or abdominal mass. Adrenal lipoma is rare and histopathological examinations should rule out a differentiated liposarcoma.
PubMed: 33845451
DOI: 10.1530/EDM-20-0204 -
Journal of Clinical Neuroscience :... Jun 2019Hereditary spastic paraplegia type-IV (HSP4) is the most common of the autosomal-dominant HSPs. Though urinary dysfunction is a frequent phenotypic feature, long-term...
OBJECTIVE
Hereditary spastic paraplegia type-IV (HSP4) is the most common of the autosomal-dominant HSPs. Though urinary dysfunction is a frequent phenotypic feature, long-term pollakisuria as the initial manifestation of HSP4 has not been reported.
CASE REPORT
The patient is a 56yo female with an uneventful history until age 46y, when she developed pollakisuria. After another 6y she developed a coordination disorder, recognized as difficulties with running and climbing stairs. Since 6 m prior to presentation, she recognized mild dysphagia. The further history was positive for strabismus, varicosity, hepatopathy, thiamin-deficiency, niacin-deficiency, lumbago, cutaneous borelliosis, abortive psoriasis, lumbar spondylosis, osteochondrosis L5/S1, and HLA-B27-positive rheumatoid arthritis. Clinical exam revealed mild weakness for left foot extension (M5-), a right subclonic patella tendon reflex, and mildly impaired left hook transition. Nerve conduction studies revealed subclinical polyneuropathy. Ophthalmologic investigations, and MRI of the brain and spinal cord were non-informative. Genetic work-up revealed the novel variant c.683-2A > C in the SPAST gene. The family history was positive for HSP in her mother and sister. Pure HSP4 was diagnosed.
CONCLUSIONS
Pure HSP4 may manifest at onset with year-long pollakisuria exclusively. HSP4 may take a mild course over years, allowing the patient to do sports and to practice a demanding job.
Topics: Adult; Female; Humans; Mutation; Polyuria; Spastic Paraplegia, Hereditary; Spastin
PubMed: 30962061
DOI: 10.1016/j.jocn.2019.03.067 -
Journal of Surgical Case Reports Oct 2023The application of indocyanine green (ICG) has recently been reported to aid in the resection of endometriosis in the bladder wall and/or involving the ureters. A...
The application of indocyanine green (ICG) has recently been reported to aid in the resection of endometriosis in the bladder wall and/or involving the ureters. A symptomatic 41-year-old patient with dysmenorrhea and pollakisuria was referred to our tertiary center. Imaging revealed a 1.5-2 cm intramural endometriotic nodule in the posterior bladder wall. She was planned for robotic resection of the endometriotic nodule, under ICG guidance, together with a hysterectomy. After placement of double-J ureteral stents and clamping the bladder, perforation of the bladder mucosa could be avoided whilst performing a circumferential resection of the nodule. By clamping the bladder catheter after instillation of ICG, both the bladder wall thickness and ureters could be visualized with near-infrared imaging during robotic resection of the endometriotic nodule and hysterectomy. With the surgical approach described here, endometriotic nodules/tissue can be removed precisely with enlarged vision at the robot console, safely, and completely without damaging adjacent tissues.
PubMed: 37942346
DOI: 10.1093/jscr/rjad604 -
European Urology Focus Nov 2022Although bacillus Calmette-Guerin (BCG) is a standard treatment for high-risk non-muscle-invasive bladder cancer (NMIBC), a high rate of adverse events with a variety of... (Randomized Controlled Trial)
Randomized Controlled Trial
Effect of Levofloxacin on the Efficacy and Adverse Events in Intravesical Bacillus Calmette-Guerin Treatment for Bladder Cancer: Results of a Randomized, Prospective, Multicenter Study.
BACKGROUND
Although bacillus Calmette-Guerin (BCG) is a standard treatment for high-risk non-muscle-invasive bladder cancer (NMIBC), a high rate of adverse events with a variety of grades remains a difficulty.
OBJECTIVE
In this randomized, prospective, multicenter study, we examined whether levofloxacin, given after each intravesical instillation of BCG, could improve its tolerance in patients with intermediate- to high-risk urothelial carcinoma of the bladder without compromising its efficacy.
DESIGN, SETTING, AND PARTICIPANTS
Overall, 106 Japanese patients (85 men and 21 women; age: median, 69.5 yr) with primary or recurrent NMIBC were randomized after transurethral resection to induce treatment with intravesical BCG plus levofloxacin (group 1) or BCG alone (group 2).
INTERVENTION
Patients who underwent intravesical instillation of BCG were randomized with or without levofloxacin administration.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Adverse events were assessed using the National Cancer Institute-Common Toxicity Criteria version 3.0. Cumulative incidence functions and Kaplan-Meier methods were applied to estimate survival outcomes.
RESULTS AND LIMITATIONS
There was no significant difference in baseline characteristics between the groups. The completion rate of group 1 (85.5%) was not significantly lower than that of group 2 (76.5%; p = 0.321). There was no significant difference in the completion rate of patients with pollakisuria, painful micturition, gross hematuria, fever elevation, and others between the groups. The incidence of adverse events in patients with high-grade pollakisuria (7.3% vs 25.4%, p = 0.041) and fever (0% vs 9.1%, p = 0.034) was significantly lower in group 1. The 5-yr progression-free and cancer-specific survival rates were significantly better in group 1.
CONCLUSIONS
Prophylactic levofloxacin administration may reduce the severity of adverse events and contribute to better outcomes from BCG intravesical therapy in patients with NMIBC.
PATIENT SUMMARY
Levofloxacin administration seems to be a safe and effective therapy for non-muscle-invasive bladder cancer patients treated with bacillus Calmette-Guerin intravesical therapy.
Topics: Humans; Female; BCG Vaccine; Carcinoma, Transitional Cell; Urinary Bladder Neoplasms; Levofloxacin; Prospective Studies
PubMed: 35717522
DOI: 10.1016/j.euf.2022.06.002