ABSTRACT
Importance: Women with interstitial cystitis/bladder pain syndrome (ICBPS) face isolation and treatment challenges. Group medical visits using Centering models have successfully treated other conditions but have not been explored in ICBPS. Objective(s): This study aimed to describe ICBPS pain and symptom control comparing standard treatment alone versus standard treatment augmented with Centering visits. Study Design: This prospective cohort study recruited women with ICBPS receiving standard care (control) or standard care augmented with group Centering. We administered validated questionnaires at baseline and monthly for 12 months. The primary outcome was change in the pain numerical rating scale, with Patient-Reported Outcomes Measurement Information System Pain Interference Scale and Bladder Pain/Interstitial Cystitis Symptom Score change as secondary measures. Result(s): We enrolled 45 women (20 Centering, 25 controls). Centering had significantly better numerical rating scale pain scores at 1 month (mean difference [diff], -3.45) and 2 months (mean diff, -3.58), better Patient-Reported Outcomes Measurement Information System Pain Interference Scale scores at 1 month (mean diff, -10.62) and 2 months (mean diff, -9.63), and better Bladder Pain/Interstitial Cystitis Symptom Score scores at 2 months (mean diff, -13.19), and 3 months (mean diff, -12.3) compared with controls. In modeling, treatment group (Centering or control) and educational levels were both associated with all the outcomes of interest. Beyond 6 months, there were too few participants for meaningful analyses. Conclusion(s): Women with ICBPS participating in a Centering group have, in the short term, less pain, pain interference, and ICBPS-specific symptoms than patients with usual care alone. Larger studies with more follow-up are needed to determine if this treatment effect extends over time.Copyright © 2022 American Urogynecologic Society. All rights reserved.
ABSTRACT
INTRODUCTION: SARS-COV-2 is associated with unexpected symptoms. Several studies in adults reported urinary frequency with COVID-19. The aim of this study is to reveal lower urinary tract symptoms associated with COVID-19 (CALUTS) in children. PATIENTS-METHODS: All children diagnosed with COVID-19 and associated multisystem inflammatory syndrome in children (MIS-C) between November 2020-June 2021 in our hospital were reviewed and asked for urinary symptoms at the time of or following their disease. The ones reporting symptoms were invited for further evaluation. Parents were inquired for their child's former bladder and bowel function, their symptoms after the diagnosis of COVID-19 or MIS-C, onset and duration of the symptoms, and their current state. They were questioned for the frequency of voiding as well as dysuria, odor, and the presence of incontinence as well as other symptoms of COVID-19. The patients who reported symptoms at the time of inquiry were followed for cessation of symptoms. The parameters age, sex, need for hospitalization and admission to ICU were also compared to the whole group to evaluate the main characteristics of patients with lower urinary tract symptoms. RESULTS: In total 20 patients (18/216 with acute disease and 2/36 with MIS-C) reported CALUTS (figure). Age and sex distribution were not significantly different from the patients without urinary symptoms (p = 0.777 and p = 0.141 respectively). All were otherwise healthy children with no concomitant chronic diseases other than overactive bladder in two. There were 13 girls and 7 boys. Mean age was 11 years (±5 years). Thirteen of the patients were older than 10 years; however, there were also 3 children under 5 years of age. All parents described a sudden onset of extremely increased urinary frequency and urgency lasting for weeks which disappeared gradually. Median bladder and bowel dysfunction questionnaire (BBDQ) score before COVID-19 was 2.5 (1-18) which increased to a median of 22 (15-29) at the time of the symptoms (p < 0.001). The timing of onset and duration of symptoms were variable and not associated with symptom severity (p = 0.306 and p = 0.450 respectively). Eight patients (40%) reported diarrhea. The duration of diarrhea was limited to less than one week in all. CONCLUSIONS: Our study revealed that SARS-COV-2 can be associated with lower urinary tract symptoms also in children both during the acute phase and MIS-C. Further studies are necessary to understand the etiopathogenesis and prevalence of this unexpected aspect of COVID-19.
ABSTRACT
CASE: A 30-year-old woman with a history of hypertension, obesity, and reactive airway disease presents with a two-month history of persistent cough, wheeze, and diaphoresis. At that time, chest x-ray and COVID-19 PCR were negative and pulmonary function tests were within normal limits. Her symptoms were managed with inhaled corticosteroid/long-acting muscarinic antagonist, albuterol, guaifenesin, and second-generation antihistamines. However, she continued to be symptomatic. Two months after these symptoms arose, she presented to the ED with a sixhour history of sudden onset right non-radiating flank pain. Her symptoms were associated with acute onset nausea, vomiting, urinary frequency, urgency, hesitancy, and burning;negative for hematuria. She was hemodynamically stable and physical exam was significant for right flank tenderness. Urinalysis showed proteinuria of 100 mg/dL and gross hematuria. Imaging of the abdomen demonstrated an enlarged right kidney with a large mass involving the cortex with mass effect on the liver. Urology performed a right radical nephrectomy with pathology positive for chromophobe renal cell carcinoma. Following surgery, the patient's original symptoms of cough, wheezing, and diaphoresis resolved. IMPACT/DISCUSSION: The typical symptomatic presentation of renal carcinoma with flank pain, abdominal mass, hematuria, and weight loss occurs in roughly 9% of cases and is indicative of advanced disease. Renal cell carcinoma is most commonly found incidentally on imaging studies, leading to improved outcomes due to early recognition. Young patients, however, are more likely to present symptomatically. Our patients' initial presentation of cough could be due to two different mechanisms. One possibility is chronic irritation of the diaphragm due to mass effect from the growing tumor. This mechanism is possible in our case as there was minor mass effect on the liver which could then disturb the diaphragm. A more likely mechanism is a paraneoplastic process. This has been demonstrated in prior cases with a chronic unremitting cough associated with diaphoresis, not improved with anti-tussives, and resolves upon removal of the mass. The cough has been shown to return with metastases. The proposed mechanism is tumor secretion of prostaglandins which enhance the cough reflex. Our case displays an uncommon symptomatic presentation of renal cell carcinoma in a young woman due to paraneoplastic cough stimulation. This demonstrates the importance of digging deeper when common symptoms such as cough are not successfully resolved with typical treatments. CONCLUSION: Most commonly renal cancer is diagnosed on incidental imaging allowing clinicians to make a diagnosis before symptoms arise. An unremitting cough may be an early warning sign of renal cell carcinoma before urinary symptoms begin, making early diagnosis more likely. Due to this, seemingly minor symptoms such as cough should be followed through to diagnosis as they can have significant consequences.
ABSTRACT
The current coronavirus disease 2019 (COVID-19) pandemic is a challenge for physicians in triaging patients in emergency rooms. We found a potentially dangerous overlap of classical urinary symptoms and the as yet not fully described symptoms of COVID-19. After a patient was primarily triaged as a urosepsis case and then subsequently diagnosed with COVID-19, we focused on an increase in urinary frequency as a symptom of COVID-19 and identified this in seven males out of 57 patients currently being treated in our COVID-19 wards. In the absence of any other causes, urinary frequency may be secondary to viral cystitis due to underlying COVID-19 disease. We propose consideration of urinary frequency as an anamnestic tool in patients with infective symptoms to increase awareness among urologists during the current COVID-19 pandemic to prevent fatal implications of misinterpreting urological symptoms.