Iintravesical instillation of bacillus calmette guerin versus intravesical instillation of hyaluronic acid in the treatment of interstitial cystitis

The study included thirty adult female patients with a mean age of [40-50y] with a interstitial cystitis. Patients were divided into two equal groups. First group was treated with intravesical installation of hyaluronic acid 40 my in 50-ml solution weekly repeated for 4 weeks then once monthly for 6 months. The second group was treated with intravesical installation of BCG [Tic strain] 40 my in 50-ml solution weekly repeated for 6 weeks. Evaluation was done according to symptom score. Improvemen occurred in both groups. With hyaluronic acid, maximum response reached by 24 weeks in which positive response occurred in 66.6% [complete response 13.3% and partial response 53.3%]. By the end of 48 weeks positive response decreased to 40% [complete response 6.6% and partial response 33.3%]. No reported complication in this group. With BCG, maximum response reached by 12 weeks in which positive response occurred in 73.3% [complete response 20% and partial response 53.3%]. However by the end of 48-week positive response decreased to 60% [complete response 13.3% and partial response 46.6%]. Microscopic haematuria occurred in 53.3% and symptoms of bladder irritability were increased in 20%, but disappeared spontaneously in 6 weeks. Both intravesical BCG and hyaluronic acid installation are effective in the treatment of interstitial cystitis. With BCG the maximum response started early, maintained for prolonged duration and persisted for the period of follow up of 48 3 weeks in 60%. But with intravesical hyaluronic acid the response persisted for the period of follow up of 48 weeks in 40% only

Comparing the effect of topical eutectic mixture of local anesthesia and lidocaine infiltration on pain response and analgesia requirement during extra corporeal lithotripsy procedure [using the storz modulith SL20]

Fifty adult male patients [mean age 35 +/- 15 ys.] with renal pelvic stones were selected for this study, all patients required 3 ESWL sessions. First session was performed without any form of preoperative analgesia or anaesthesia. Second session, patients received 25mg of EMLA cream applied locally to cover a skin area overlying the treated kidney, 90 minuets before ESWL session. Third session was started 10 minuets after subcutaneous infiltration to the area overlying the treated kidney with 20 ml, 1% lidocaine. Using EMLA cream and lidocaine subcutaneous infiltration lead to decrease the pain score perception when compared to without anaesthesia session. During the first 500 shock waves of ESWL, pain score of 2 or more was reported by 6%, 10% and 35% of patients using EMLA cream, lidocaine infiltration and without anaesthesia respectively, and 38%, 32% and 70% during the following 2500 shock waves. This decrease in pain score lead to less need for I.V. alfentanil analgesia to 38% in case of using EMLA cream, 32% in case of using lidocaine infiltration, while it was 70% when nothing was used. Local anesthesia is an effective means to reduce the pain score and analgesia requirement during extra corporeal lithotripsy procedure. Both EMLA and local infiltration are effective. However EMLA cream is easy to apply and has no complications. It is only drawback is its price