Ms. Li, 37 years old, recurrent urinary frequency and urgency for 9 years, at first it was just a lot of times at night, and did not care, with some anti-inflammatory drugs to eat, many hospitals have seen the problem, but also always no good ah, now it is to 7 to 8 times during the day. And the little stomach often throbbing ah, not only affect the work during the day, not sleep well at night, even married life is affected. Work and life are not smooth ah, Ms. Zhang is worried to death. A few days ago, a friend referred her to the Department of Urology at Jiaxing First People’s Hospital, where she was diagnosed with interstitial cystitis after a detailed history, urinalysis, cystoscopy and urodynamic tests. Finally, the cause of the disease that has been bothering her for a long time was clarified.
The doctor there said: Interstitial cystitis, also known as painful bladder syndrome, is a chronic, non-bacterial inflammation of the bladder that causes pain and distress to the patient, which initially resembles inflammation of the bladder but is not effective with antibiotics. It can cause persistent discomfort or pain in the bladder and adjacent pelvic area. The disease is characterized by painful, frequent, and urgent urination. The initial cause of IC is due to stress and sensitivity, and it is for this reason that more women than men suffer from IC, with 90% of IC patients being female. The diagnosis is not difficult, but it is necessary to exclude other diseases that may cause IC symptoms: bladder cancer, tuberculous cystitis, kidney stones, prostatitis in men, kidney disease, vaginitis, sexually transmitted diseases, endometriosis, radiation cystitis, and neurological or rheumatic disorders.
Current treatment with non-invasive techniques, such as modified diet and self-help, can be used in combination with other more damaging treatments and is considered the preferred step in relieving the symptoms of interstitial cystitis. The response to treatment varies from person to person; acid is an important factor in the pathogenesis of IC, so many foods containing acid are not allowed in IC patients, and if eaten, they should be neutralized by alkaline medications.
Oral medication: The most commonly used drugs in our department are tricyclic antidepressants: almitriptyline (Elavil), doxorubicin (Sinequan) and other muscle relaxants such as Valium and baclofen tablets for pain. Antispasmodics such as gabapentin (Neurontin) and clonidine (Klonopin) and short-acting opioid analgesics such as Vicodin and Percocet have been reported to be used to treat moderate and intermittent pain caused by interstitial cystitis.
The following bladder instillations can be added to the treatment regimen if necessary.
DMSO (dimethyl sulfoxide), Rimso 50: Approved for interstitial cystitis in 1978. Direct instillation into the bladder. Considered to be an anti-inflammatory agent. DMSO can be used in combination with steroids, heparin and/or local anesthetics.
Heparin: Has dual anti-inflammatory and epidermal protective effects. Heparin mimics the activity of the bladder mucosa epithelium and temporarily “repairs” the mucopolysaccharide layer.
Clorpactin WCS-90 (sodium oxycloxan) – although it has been used in the clinic in dilute solution, it can be very painful and requires general anesthesia.
Surgical treatment :
Laser treatment: has been used successfully to treat Hunner’s ulcers (or spots) present in 5-10% of patients with interstitial cystitis. Other uses of laser therapy for interstitial cystitis are not clinically approved. Therefore, laser surgery is only used for ulcerative disease in interstitial cystitis
Surgery: only as a last resort to be considered. Several procedures have been used to treat interstitial cystitis, including bladder augmentation, urinary diversion, and internal capsule construction, but surgery can lead to serious complications and these operations may not provide pain relief.
Of note are the ineffective treatments for interstitial cystitis: urethral dilatation , urethrotomy.
The latest recent developments:
Cystistat
Bioniche Life Sciences, Inc. is a Canadian biopharmaceutical company. It has initiated a multicenter, placebo-controlled study of Cystistat (sodium hyaluronate) for the treatment of interstitial cystitis (IC). Intracapsular use of sodium hyaluronate is thought to work by directly contacting the mucosal epithelium of the bladder defect (the accepted theory of the etiology of interstitial cystitis) and replacing the damaged layer. The only non-animal-derived sterile sodium hyaluronate solution available in China is “InterStim” for intravesical infusion to repair damaged mucosa.
InterStim?
A neuromodulation device called InterStim urinary control therapy, manufactured by Medtronic. It may now be considered for the treatment of interstitial cystitis when other conservative therapies have failed. Although not yet approved for the treatment of interstitial cystitis, preclinical studies have been completed and are currently being conducted by the FDA. InterStim consists of a small, surgically implanted device that delivers mild electrical stimulation to nerves in the lower part of the back (just above the tailbone). These nerves affect the bladder and the surrounding muscles that control urination. the InterStim system is usually surgically implanted in the subcutaneous tissue of the lower back. The treatment has been introduced in our department on a small scale, but the long-term efficacy needs to be further observed. The biggest disadvantage is that it costs up to $100,000.
SI-7201 (Sodium hyaluronate)
Seikagaku is conducting a double-blind, placebo-controlled, multicenter clinical study to evaluate the safety and efficacy of intracapsular infusion of sodium hyaluronate solution (SI-7201). It is believed that SI-7201 works by providing a protective film to the bladder epithelium.
RTX (resiniferatoxin)
RTX capsaicin analogue, esiniferatoxin, is thought to be able to serve as a new drug for the intraluminal treatment of interstitial cystitis. When placed directly into the bladder, RTX works by “isolating” the sensory neurons of the bladder. Treating interstitial cystitis with RTX may help relieve not only urinary urgency and frequency, but also bladder pain. However, it is not approved in the United States.
Botulinum toxin
Researchers are conducting studies on the intracapsular use of botulinum toxin for interstitial cystitis. By studying the nerve pathways affected by Botox, they hope to provide new targets and treatments for interstitial cystitis. Interstitial cystitis cannot be treated with botulinum toxin in the United States at this time. However, clinical studies are being planned.