Utilization of pretransplant cystography and hydrodistention among anuric patients on renal replacement therapy and its impact on cost and timing of transplantation

OBJECTIVE@#To describe utilization of pretransplant cystography and hydrodistention among anuric end stage renal disease patients (ESRD) on renal replacement therapy (RRT) and its impact on cost and timing of transplantation.@*METHODS@#A chart review was done on all anuric ESRD pretransplant patients on renal replacement therapy who underwent cystography and hydrodistention from 2014 to 2019. The authors analyzed patient demographics, post-transplant outcomes, process indicators and costs incurred due to cystography and hydrodistention.@*RESULTS@#A total of 151 patients were included in the study. There was female predominance (86, 57%) with a median age of 32 (range 18-61) years. Majority of the patients underwent hemodialysis (144, 95%). Glomerulonephritis was the prevailing etiology of ESRD (119, 79%). Majority had normal bladder capacity (107, 71.5%), while 44 (29%) patients had small bladder capacity who subsequently underwent hydrodistention. There is a moderately negative correlation between bladder capacity and duration of dialysis and anuria. Hydrodistention did not significantly increase duration from diagnosis to kidney transplant (4.2 vs 3.5 months; p = .083). Median cost of cystography was Php 4377 (range 1978 – 5282) and the average total cost incurred per patient due to hydrodistention was Php 643.53.@*CONCLUSION@#Longer duration of RRT and anuria yields to lesser bladder capacity. Cystography is recommended in ESRD patients who are anuric for at least three years. Hydrodistention does not significantly prolong duration of diagnosis to kidney transplant.

Therapeutic Endoscopic Treatment Plus Maintenance Dimethyl Sulfoxide Therapy Prolongs Recurrence-Free Time in Patients With Hunner Type Interstitial Cystitis: A Pilot Study / 대한배뇨장애요실금학회지

PURPOSE: To evaluate whether hydrodistention with fulguration of Hunner lesions (HD/FUL) plus maintenance dimethyl sulfoxide (DMSO) therapy prolongs the recurrence-free time in patients with Hunner type interstitial cystitis (IC).METHODS: The study enrolled patients with Hunner type IC who required repeat HD/FUL due to recurrence of IC symptoms after the first HD/FUL at our institution. All patients received a second HD/FUL plus maintenance DMSO therapy. The maintenance DMSO therapy was performed every 2 weeks for a total of 8 instillations, and then once every 4 weeks thereafter. The recurrencefree time from HD/FUL to therapeutic failure was estimated using the Kaplan-Meier method. The recurrence-free time between the first HD/FUL and second HD/FUL plus maintenance DMSO therapy was statistically compared using the log-rank test.RESULTS: A total of 21 patients (mean age, 66.3±10.8 years) with Hunner type IC were evaluated. The recurrence-free time for the second HD/FUL plus maintenance DMSO therapy was significantly longer than that for the first HD/FUL (P<0.0001). The median recurrence-free time for the first HD/FUL was 10.1 months, while that for the second HD/FUL plus maintenance DMSO therapy has yet to be reached. The recurrence-free rate for the first HD/FUL was 81.0% at 6 months, 38.1% at 1 year, 9.5% at 2 years, and 4.8% at 3 years. In contrast, the rate for the second HD/FUL plus maintenance DMSO therapy was 100% at 6 months, 94.7% at 1 year, 82.6% at 2 years, and 82.6% at 3 years. There were no significant differences in efficacy between the first and second HD/FUL.CONCLUSIONS: HD/FUL plus maintenance DMSO therapy clearly prolongs the recurrence-free time compared with HD/FUL alone in Hunner type IC.

Intravesical injection of botulinum toxin A for treatment of interstitial cystitis/bladder pain syndrome: 13 years of experience / 中华泌尿外科杂志

Objective To evaluate the efficacy of the intravesical injection of botulinum toxin A (BTX-A) and bladder hydrodistention plus sodium hyaluronate (Cystistat) instillation in patients with interstitial cystitis/bladder pain syndrome (IC/BPS).Methods We retrospectively reviewed 153 women with IC/BPS from January 2003 to December 2015.Of the 153 patients,77 were treated with BTX-A(group A),the average age was (56.0 ± 4.1) years old.76 underwent bladder hydrodistention plus sodium hyaluronate (Cystistat) instillation (group B),the average age was (58.0 ± 3.3) years old.The patients were evaluated using the O'Leafy-Saint score,visual analog scale pain score,urinary frequency record and quality of life questionnaire before treatment and 1 week,1,3,6 and 12 months after treatment.Results In group A,only 2 had acute urinary retention,27 received a repeat injection,and 28 were lost to follow-up.In group B,3 had urinary tract infection,15 switched to BTX-A injection at 6 months because the treatment of hydrodistention plus Cystistat instillation is not good.31 were lost to follow-up.BTX-A was shown to remain effective for up to 6 months after treatment.After repeated Chinese BTX-A injections,symptoms improved significantly.Hydrodistention plus Cystistat remained effective for up to 3 months after treatment.Conclusions Intravesical injection of BTX-A is a effective therapeutic option for patients with IC/BPS.The average duration of the effect of one dose of Chinese BTX-A was 6 months.Repeated injection of BTX-A is effective.

The clinical effectiveness of detrusor combined triangle injection of Botulinum toxin type A plus hydrodistention in treating interstitial cystitis/bladder pain syndrome / 中华泌尿外科杂志

Objective To evaluate the effectiveness and security of Botulinum toxin type A (BTX-A) in treating interstitial cystitis /bladder pain syndrome,and also the effect of different site injection.Methods Sixty-nine consecutive BPS/IC patients from October 2011 to February 2016 were divided into three groups randomly,including control group (group A) and treatment group (group B and group C).There were 5 males and 64 females,with age from 23 to 66 years old (average 44.5 years old).Twentythree patients (1 male and 22 females,aged from 23 to 69 years old,with mean age of 44.6 years old) in control group (group A) underwent hydrodistention.Twenty-four patients (2 males and 22 females,aged from 27 to 65 years old,with mean age of 42.8 years old) in group B underwent BTX-A detrusor combined triangle injection plus hydrodistention.Twenty-two patients (2 males and 20 females,aged from 30 to 68 years old,with mean age of 44.3 years old) in group C underwent BTX-A triangle injection alone plus hydrodistention.The parameters such as daytime frequency,nocturia,visual analogue scale/score (VAS),functional cystemetric volume (FCV),post-void residual volume (PVR),QOL score,maximal bladder capacity (MBC),interstitial cystitis symtom index (ICSI),interstitial cystitisproblem index (ICPI),Qmax,and Hamilton anxiey scale (HAMA) score between pre-treatment and 1,3,6 and 9 months after therapy in the three groups were compared.Results There were no serious complications observed in the three groups.All parameters 1 month after therapy were obviously superior to that of pretreatment.The efficacy in control group decreased significantly 3 months after treatment except nocturia (3.0 vs.5.0),daytime frequency(7.0 vs.14.0)and Q (14.0 ml/s vs.13.0 ml/s).However,all parameters in research groups except PVR were still obviously superior to pretherapy.The parameters except Q and nocturia in group B had statistically significant difference from contemporaneous group A (all P ＜ 0.05).However,the parameters except Q nocturia and somatic anxiety score in group C had statistically significant difference from contemporaneous group A (all P ＜ 0.05).VAS (2.0 vs.3.0) and somatic anxiety score (6.0 vs.10.0) in group B were superior to group C (all P ＜ 0.05).When it came to 6 months after therapy,urinary frequence and urgency and pain symptoms were the same to pretherapy and all parameters had no statistically significant difference between pretherapy and after therapy in group A(all P ＞ 0.05).But all parameters except PVR in research group was still superior to pretherapy.the parameters except PVR,Q and QOL in group B had statistically significant difference from contemporaneous group A (all P ＜ 0.05).However,The parameters except PVR,Q MBC,ICSI and QOL in group C had statistically significant difference from contemporaneous group A (all P ＜ 0.05).Meanwhile,efficacy in group B was better than group C in term of ICPI (6.0 vs.8.0) and somatic anxiety score (7.0 vs.10.0) (all P ＜ 0.05).The efficacy decreased significantly 9 months after treatment in both group B and C,with no statistically significant difference compared with that of pretreatment.ICSI(10.0 vs.13.0),ICPI(9.0 vs.13.0),QOL(5.0 vs.6.0)in group B,and QOL(5.0 vs.6.0)in group C had statistically significant difference compared with the contemporary parameters in group A.ICSI(10.0 vs.12.0),MBC(285.0 ml vs.237.5 ml) in group B was better than that in group C (P ＜ 0.05).Conclusions Symptoms in IC/BPS patients can be alleviated significantly by detrusor BTX-A injection plus hydrodistention.Quality of life can be improved remarkably and HAMA scores can be reduced significantly after treatment.Thus,it's an effective therapeutic mnethod for IC/BPS,and detrusor combined triangle injection can provide a better effect than single triangle injection.

Random bladder biopsy and hydrodistention with cystoscopy under anesthesia play an important diagnostic and therapeutic role in bladder pain syndrome/interstitial cystitis / 中华泌尿外科杂志

Objective To evaluate the diagnostic and therapeutic role in bladder pain syndrome/interstitial cystitis (BPS/IC) of random bladder biopsy and hydrodistention with cystoscopy under anesthesia.Methods A retrospective review of cases in our BPS/IC center was performed from 2005 to 2010. One hundred and nineteen patients were included who are diagnosed as the bladder pain syndrome/interstitial cystitis (BPS/IC).There were 32 male patients,aged 47 to 64 years,and 56 years on average; 87 female cases,aged 23 to 67 years,49 years on average.Patients with bladder pain symptoms underwent a thorough evaluation which include voiding diary,pelvic pain、urgency and frequency questionnaire,urine culture,cytology,acid fast bacilli and upper tract imaging.Cystoscopy and random bladder biopsy had been undertaken with general anesthesia.Before and after hydrodistention with cystoscopy,the patients daily frequency of urination,the maximum urine volume,pain scores,symptom scores,QOL score were observed to understand whether there are significant improvement. Results One hundred and nineteen BPS/IC cases underwent random bladder biopsy and hydrodistention with cystoscopy under anesthesia,and finally 102 cases were confirmed of IC; 17 cases were not IC. Eight patients who were previously diagnosed as BPS/IC were found bladder transitional cell carcinoma as the cause of bladder pain symptoms( including 4 cases carcinoma in situ,1 case Low grade non-invasive bladder cancer,3 cases High grade invasive bladder cancers),and 4 of whom had no hematuria. Mean time from the occurrence of BPS to diagnosis of transitional cell carcinoma was 10.8 months. Three patients previously diagnosed as BPS/IC were found tuberculous cystitis as the cause of symptoms,and one eosinophilic cystitis,three chemical cystitis,two radiation cystitis were also detected.Before hydrodistention with cystoscopy under anesthesia,the daily frequency of urination in 102 cases diagnosed for IC patients was 42.1 ±5.6; the maximum urine volume was 141.0 ± 8.3 ml; pain score 7.6 ± 3.0; O'Leary-Sant questionnaire symptom score was 27.7 ± 4.2; QOL score was 7.6 ± 2.4.After hydrodistention with cystoscopy under anesthesia,the daily frequency of urination in 102 IC patients was 23.3 ± 3.4,and the maximum urine volume was 352.0 ± 1.7 ml ; pain score was 3.3 ± 4.3 ; O'Leary-Sant questionnaire symptom score was 12.5 ± 7.3 ; QOL score was 3.2 ± 5.1. Before and after hydrodistention with cystoscope under anesthesia,all of the daily frequency of urination,the maximum urine volume,pain scores,symptom scores,QOL score in 102 IC patients were significant improved (P ＜ 0.05 ). Conclusions BPS/IC remains a diagnosis of exclusion.Random bladder biopsy and hydrodistention with cystoscopy under anesthesia play an important diagnostic and therapeutic role in BPS/IC.

Treatment of ketamine-associated bladder dysfunction with bladder hydrodistention / 中国综合临床

Objective To evaluate the efficacy and safety of bladder hydrodistention for the treatment of ketamine-associated bladder dysfunction.Methods Six patients were required to withdraw the ketamine and treated with bladder hydrodistention therapy and sodium hyaluronate irrigation,and medicine to pretect liver and kidney was also used.Results The biopsies of 6 cases demonstrated the cystitis through biopsy.Lower urinary tract symptoms such as urgency,thamuria and odynuria were significantly relieved after bladder installation within 30 days.The O'Leary-Sant ICSI scores and the ICPI scores reduced to 3.5 ± 1.6,2.8 ± 1.5 respectively.The functional bladder capacities increased to an anverage of (180 ± 28)ml,.2-3 times of nocturia,Qmax (14.4 ± 4.3) ml/s.All cases were followed up for 4 to 18 months.Symptoms disappeared or were significantly relieved in all patients.Conclusion Contracture of bladder might be the main presentation of ketamine-associated bladder dysfunction.Intravesical hydrodistention therapy and sodium hyaluronate irrigation could be the safe and effective therapy in the treatment of katamine-associated dysfunction.

Clinical analysis of the diagnosis and treatment of male interstitial cystitis: report of 18 cases / 中华泌尿外科杂志

ObjectiveTo investigate the diagnosis and the treatment of male interstitial cystitis (IC) to improve the efficiency.MethodsEighteen cases of IC male patients treated from Jan 2010 to Dec 2010 who suffered from suprapnbic pain urinary frequency and urgency were analyzed retrospectively.All these patients were misdiagnosed as category Ⅲ chronic prostatitis.According to the NIDDK diagnostic criteria of IC,Pelvic Pain and Urgency Frequency (PUF) scoring,potassium sensitivity test (PST),and cystoscopy under anaesthesia were used to establish the diagnosis of IC.24 h urinary diary,routine uronoscopy,prostate fluid routine and bacterial culture examination were taken before the treatment of hydrodistention and intravesical instillation of heparin.ResultsAfter the follow-up 12 to 25 months ( average,19 months),the symptoms improved distinctly.The PUF scoring was 19.2 ±4.1 before treatment and 13.6 ±2.4 after treatment respectively ( P ＜ 0.01 ).24 hours' frequency and amount of urination were (7.5 ± 4.3)times and (241.7 ±45.3) ml after treatment compared with (11.5 ±3.9) times and (159.5 ±30.8) ml before treatment ( P ＜ 0.01 ).ConclusionsThe male IC and chronic prostatitis share the same symptoms.They can be differentiated by the IC diagnosis.The treatment of hydrodistention alone with oral tolterodine tartrate sustained release tablets and intravesical instillation of heparin can evidently improve the symptoms of the male IC patients.

Efficacy of Hydrodistention Implantation Technique in Treating High-Grade Vesicoureteral Reflux

PURPOSE: In the endoscopic treatment of vesicoureteral reflux, the relatively high rate of success, the simplicity of the procedure, high patient compliance, and a lack of complications has led to the increased development of injection materials and techniques. We report a method of identifying and maintaining a clear visual field during ureteral and bladder submucosal wall injection of a dextranomer/hyaluronic acid copolymer (Deflux, Oceana, Therapeutics Inc.) by use of the hydrodistention implantation technique (HIT) with the aid of temporary ureteral catheter insertion. MATERIALS AND METHODS: We prospectively reviewed patients with grade IV or V reflux who received an endoscopic injection of Deflux. Reflux grade was evaluated before and after treatment (3 months) by use of voiding cystourethrograms. Conventional sub-trigonal injection (STING) was performed with injection of Deflux underneath the bladder mucosa at the 6 o'clock position. HIT was performed either with hydrodistention or with guidewire insertion. These techniques increase visualization of the intramural portion of the distal ureteral wall. Patients with treatment failures were offered reinjection up to three times. RESULTS: Sixty-three patients completed endoscopic injection and follow-up of 3 months. The overall resolution rate for conventional STING was 58%, i.e., 67% for grade IV and 43% for grade V. The overall resolution rate for HIT was 80%, i.e., 93% for grade IV and 66% for grade V. The modified methods showed higher resolution rates for overall cure owing to the success in patients with grade IV reflux (p=0.026). Although the success of grade V treatment was higher with the modified method, the success rate was not statistically significant (p=0.27). CONCLUSIONS: HIT with the use of either hydrodistention or a guidewire to aid in visualization of the intramural portion of the distal ureter is an effective treatment for high-grade vesico-ureteral reflux.

Intravesical instillation resiniferatoxin and hydrodistention for the treatment of interstitial cystitis / 国际外科学杂志

Objective To evaluate the efficacy of bladder hydredistention and resiniferatoxin(RTX)on treating female interstitial cystitis(IC).Methods A total of 16 patients with IC were included.All patients received cystoscopie hydrodistention and RTX under anesthesia.The O'Leary-Sant Interstitial Cystitis Symptom Index(ICSI),Problem Index(ICPI),voiding frequency and the maximum bladder capacity were recorded before and after the therapy.Results All patients were followed up for 1 or 6 months.Fourteen of 16patients'symptoms were relieved,2 patients symptoms disappeared or significantly relieved.Conclusion Bladder hydrodistention and RTX effectively relieve symptoms and improve quality of life in patients with IC in the short term.

The Effects of Simple Hydrodistention of Bladder in Interstitial Cystitis / 대한비뇨기과학회지

PURPOSE: We reviewed 19 patients with interstitial cystitis from March 1992 to August 1996. All patients were treated with simple hydrodistention of bladder, and we followed the results of their effect. MATERIALS AND METHODS: Most of the patients were middle aged women(mean age: 50.4 years). On cystoscopy, glomerulations were noted in all patients. Major symptoms were frequency(100%), dysuria(74%), urgency(74%) and suprapubic discomforts(47%). Simple hydrodistention was used in all patients. Mean bladder capacity was 150m1(50-280) in 1 month after procedure compared with 114m1(50-190) before procedure. Hematuria was noted during postoperative period in all patients. RESULTS: As the result of the postoperative urodynamic study, 5 out of 19 patients(26.3%) had no more symptoms, 9 patients(47.4%) was improved, but 5 patients(26.3%) showed no improvement. Sixteen of 19 patient were followed up 1.5-14(mean: 71) months, previous symptoms were recurred in 12 patients 3-4 months after the treatment. CONCLUSIONS: Even though the results show short-term effects, simple bladder hydrodistention would be one of the effective treatment modalities of interstitial cystitis.

The Significance of Glomerulation in the Diagnosis of Interstitial Cystitis / 대한비뇨기과학회지

An objective finding for the diagnosis of interstitial cystitis (IC) is the so called `glomerulation`, petechial hemorrhages that occur after distention of the bladder. Glomerulation occurs in most IC patients and although there are some reports that it occurs in the normal bladder as well, there has been no actual study carried out to confirm this and further study into this matter is needed. Therefore, we induced glomerulations in non-IC patients and compared its frequency and severity with IC patients in order to elucidate the importance of glomerulation in IC. 25 (10 males, 15 females; mean age 44.3 years) IC patients received hydrodistention between Jan 1992 to Sep 1996 at the Department of Urology at Yongdong Severance Hospital. 12 (8 males, 4 females; mean age 47.5 years) non-IC patients who were to receive urological surgery under spinal or general anesthesia were selected for hydrodistention; there were 6 ureter stone, 4 BPH, and 2 stress urinary incontinence patients. 92.0% (23/25) of IC patients and 83.3% (10/12) of non-IC patients showed glomerulation and there was no statistical significance between the two groups. 76.0% (6 grade 2, 13 grade 3 glomerulation) of IC patients and 50.0% (3 grade 2, 3 grade 3) of non-IC patients showed glomerulation of grade 2 or higher. The frequency and severity of glomerulation was in an inverse relationship with trabeculation of the bladder. The sensitivity of glomerulation in the diagnosis of IC was 92.0% whereas the specificity was low with 16.7%. These findings suggest that glomerulation is nonspecific in IC and warrants further investigation.