Patients' experience of haemorrhagic cystitis after Haematopoietic Stem Cell Transplantation: Findings from a phenomenological study.

PURPOSE: Haemorrhagic cystitis (HC) is a severe complication of haematopoietic stem cell transplantation (HSCT), which significantly affects patients' quality of life. However, no qualitative studies have described to date the experience of patients who have developed this complication. Therefore, the aim of this interpretative phenomenological study performed on 2019 was to explore the experience of patients who developed HC after HSCT. METHOD: A purposeful sample of nine patients who had experienced at least one episode of HC after the HSCT were approached. The audio-recorded interviews were transcribed verbatim and then analysed according to Giorgi's method. Member checking of the findings was also performed. RESULTS: The experience of the participants with HC after HSCT has been summarised around three main themes: "Being alerted", "It has arrived" and "It has been overcome." Patients reported to have been informed regarding the HC; after the first devastating symptoms, they reported fear and in searching for causes and strategies to alleviate the problem, which seemed to be never resolved. Patients' experience with HC is complex and experienced dramatically due to the pain and the discomforting consequences of the treatments received; they develop a sense of exhaustion that can further increase both their physical and emotional burden. The process of recovery from the huge impact, required time over the end of the HC symptoms. CONCLUSIONS: Patients' experience of HC is complex, and varies according to the various phases of the complication. HC creates an increased physical and psychological stresses that demand additional coping strategies: therefore, the emotional support of patients is crucial. Moreover, strategies used autonomously by patients to alleviate symptoms are at merit of consideration in future studies.

Childhood trauma perpetrated by close others, psychiatric dysfunction, and urological symptoms in patients with interstitial cystitis/bladder pain syndrome.

BACKGROUND: A psychosocial phenotype of interstitial cystitis/bladder pain syndrome (IC/BPS), a urogenital condition without known organic causes, was proposed. While psychosocial variables, including interpersonal maltreatment and negative affect, were studied in association with IC/BPS, the specificities of the relationships between childhood trauma by close others, psychiatric dysfunctions (negative affect and post-traumatic psychopathology), and urogenital symptoms have not been established. METHODS: 94 IC/BPS patients were recruited together with 47 patients with acute cystitis who served as clinical controls. Standardized scales were used to assess various potentially traumatizing events in childhood and adulthood as well as psychiatric (dissociation and negative affect) and urogenital symptoms. RESULTS: Among the potentially traumatizing events, those perpetrated by close others during childhood were found to be the most salient features discriminating the IC/BPS group from the control group. When divided into 2 subgroups according to their history of childhood trauma by close others, only IC/BPS patients with childhood trauma by close others had more dissociative and anxiety symptoms compared with the control group. These two subgroups did not differ in urogenital symptom severity. CONCLUSIONS: Childhood trauma by close others, rather than other types of interpersonal trauma, was a differentiating characteristic in IC/BPS patients, and a childhood trauma related psychosocial phenotype with a distinct clinical profile of dissociation and anxiety proneness was identified. Future studies should investigate whether a distinct set of pathogenic factors exists in IC/BPS patients with a history of childhood trauma by close others, even if this subgroup is not readily differentiated by urogenital symptoms.

Pyelonephritis following phenazopyridine use.

We present a case of pyelonephritis following the extended andsolitary use of over-the-counter phenazopyridine in a forty-year-oldfemale. The patient initially had uncomplicated cystitis signs andsymptoms which partially resolved with phenazopyridine and therefore she continued use. She presented to the emergency department with systemicsigns and symptoms of acute pyelonephritis. As phenazopyridine is devoidof antibacterial properties this allowed the lower urinary tractinfection to progress to acute pyelonephritis requiring intravenousantibiotics. Better patient education may preclude this complication.

Long-lasting pain-related behaviors in mouse chronic cystitis model induced by a single intravesical injection of hydrogen peroxide.

We previously established a long-lasting cystitis model by an intravesical injection of hydrogen peroxide (H2O2) into mice. In this study, we assessed the pain-related behaviors in the cystitis model. An intravesical injection of 1.5% H2O2 transiently decreased spontaneous locomotor activity at 3 h after injection, indicative of acute spontaneous pain. In contrast, licking response to a bladder distention was slowly observed as licks to the lower abdomen at 7 and 14 days after injection, which was attenuated by amitriptyline and morphine, but not by oxybutynin. These results suggest that H2O2-induced chronic cystitis model shows delayed and long-lasting painful pathological condition.

Quality of life and changes in symptom relief in patients with acute uncomplicated cystitis treated with antibiotics: a prospective, open-label, multicenter, observational study.

The purpose of this study was to investigate the effect of ciprofloxacin treatment on quality of life and symptom improvement in patients with simple cystitis. Between January 2010 and December 2010, ciprofloxacin was administered twice daily for 5 days, and changes in the patients' symptoms, the therapeutic effects, and changes in the Korean version of the Urinary Tract Infection Symptoms Assessment (UTISA) score were evaluated. Patients were classified into two groups according to the self-reported degree of symptom improvement. Significant improvement was noted in symptoms such as frequency, urgency, dysuria, tenesmus, lower abdominal discomfort, back pain, and gross hematuria. The treatment success group comprised 249 patients and the treatment failure group comprised 45 patients. Baseline frequency and urgency, tenesmus, and lower abdominal discomfort were worse in the treatment failure group, although the difference was significant only for frequency (p = 0.029) and urgency (p = 0.028). All UTISA subcategory scores showed improvement in the treatment success group, and the median time to symptom improvement was 2.40 days. In the treatment failure group, some UTISA subcategory scores showed significant improvement, including those for dysuria (1.67 to 0.89), tenesmus (1.76 to 1.08), and gross hematuria (0.80 to 0.21), although significant improvement in frequency, urgency, lower abdominal discomfort, and back pain was not observed. The UTISA questionnaire was useful in reflecting the severity of simple cystitis symptoms. Frequency, urgency, lower abdominal discomfort, and back pain were not adequately improved in the treatment failure group, with frequency and urgency being predisposing factors for treatment failure.

New self-reporting questionnaire to assess urinary tract infections and differential diagnosis: acute cystitis symptom score.

OBJECTIVE: Development and validation of a simple and standardized self-reporting questionnaire for acute uncomplicated cystitis (AUC) assessing typical and differential symptoms, quality of life and possible changes after therapy in female patients with AUC. MATERIALS AND METHODS: Literature research, development and evaluation of the Acute Cystitis Symptom Score (ACSS), an 18-item self-reporting questionnaire including (a) six questions about 'typical' symptoms of AUC, (b) four questions regarding differential diagnoses, (c) three questions on quality of life and (d) five questions on additional conditions which may affect therapy. The ACSS was evaluated in 286 women (mean age 32.3 ± 12.3 years) in the Russian and Uzbek language. Measurements of reliability, validity, predictive ability and responsiveness were performed. RESULTS: Cronbach's alpha for the ACSS was 0.89, split-half reliability was 0.92 and correlation between halves was 0.85. Mann-Whitney test revealed significant difference scores of the 'typical' domain between patients and controls (10.75 vs. 2.02, p < 0.001). The optimal threshold score was 6 points, with a 94% sensitivity and 90% specificity to predict AUC. The symptom score decreased significantly when comparing before and after therapy (10.7 vs. 2.1, p < 0.001). CONCLUSION: The new validated ACSS is accurate enough and can be recommended for clinical studies and practice for initial diagnosis and monitoring treatment of AUC. Evaluation in other languages is in progress.

[Psychosomatic aspects of chronic recurrent cystitis]. / Psychosomatische Aspekte der chronisch rezidivierenden Zystitis.

INTRODUCTION: In spite of intensive research, chronic recurrent cystitis is etiologically a still insufficiently understood clinical picture. CASE REPORT: A 52-year-old patient presented with recurrent cystitis that had been treated exclusively somatically for years for which at least a psychosomatic co-pathogenesis of magnitude of the discomfort was diagnostically representable as well as being of therapeutic utility. CONCLUSION: In recollection of a bio-psychosocial understanding of human diseases, psychosomatic considerations should be undertaken at last but not least in patients with persistent cystitis.

Longitudinal analysis of quality of life in patients receiving conformal radiation therapy for prostate cancer.

PURPOSE: To prospectively assess quality of life (QoL) in patients receiving conformal radiation therapy (CRT) for prostate cancer. PATIENTS AND METHODS: 78 men with definitive CRT for prostate cancer were entered into the study. Patients were assessed before CRT, at 40 and 60 Gy, and 2, 12 and 24 months after the end of treatment. QoL was assessed using the EORTC Quality of Life Questionnaire C30 and the prostate module PR25. Changes in mean QoL scores with time of >or= 10 points were considered clinically relevant. RESULTS: Global QoL did not change statistically significant during CRT and was slightly above baseline levels during follow-up. CRT had a statistically significant negative short-term impact on role functioning, fatigue, and PR25 urinary symptoms. The scores recovered within 2 months to 1 year after CRT. Emotional functioning and social functioning scores slightly increased during and after CRT. Role functioning decreased by > 10 points at 60 Gy and urinary symptoms decreased by > 10 points at 40 and 60 Gy. All other differences were < 10 points. A high number of concomitant diseases and having no children were negative pretreatment predictors for long-term global QoL. CONCLUSION: Definitive CRT for prostate cancer does not compromise global QoL during therapy and up to 2 years after treatment. It has a limited negative effect on role functioning, urinary symptoms and, to a lesser extent, on fatigue with restitution within 2 months to 1 year after treatment.

Recurrent urinary tract infection in girls: do urodynamic, behavioral and functional abnormalities play a role?

BACKGROUND: To determine urodynamic, behavioral and functional abnormalities predisposing to recurrent urinary tract infection in 5- to 17-year-old girls. METHODS: A prospective case-control study was carried out. A total of 148 girls met inclusion criteria. They received a careful evaluation including complete history, voiding-drinking diary, bowel questionnaire, physical investigation, sonography, voiding cystourethrogram and urodynamic investigation. RESULTS: In a multivariate model, independent risk factors for recurrent urinary tract infection included age 20 mL (OR=1.1; 95% CI, 1.0-1.1). CONCLUSIONS: Independent risk factors for recurrent urinary tract infection were age

Women's quality of life is decreased by acute cystitis and antibiotic adverse effects associated with treatment.

BACKGROUND: Although acute cystitis is a common infection in women, the impact of this infection and its treatment on women's quality of life (QOL) has not been previously described. OBJECTIVES: To evaluate QOL in women treated for acute cystitis, and describe the relationship between QOL, clinical outcome and adverse events of each of the interventions used in the study. DESIGN: Randomized, open-label, multicenter, treatment study. SETTING: Two family medicine outpatient clinics in Iowa. PATIENTS: One-hundred-fifty-seven women with clinical signs and symptoms of acute uncomplicated cystitis. INTERVENTION: Fifty-two patients received trimethoprim/sulfamethoxazole 1 double-strength tablet twice daily for 3 days, 54 patients received ciprofloxacin 250 mg twice daily for 3 days and 51 patients received nitrofurantoin 100 mg twice daily for 7 days. MEASUREMENTS: QOL was assessed at the time of enrollment and at 3, 7, 14 and 28 days after the initial visit. QOL was measured using a modified Quality of Well-Being scale, a validated, multi-attribute health scale. Clinical outcome was assessed by telephone interview on days 3, 7, 14 and 28 using a standardized questionnaire to assess resolution of symptoms, compliance with the prescribed regimen, and occurrence of adverse events. RESULTS: Patients experiencing a clinical cure had significantly better QOL at days 3 (p = 0.03), 7 (p < 0.001), and 14 (p = 0.02) compared to patients who failed treatment. While there was no difference in QOL by treatment assignment, patients experiencing an adverse event had lower QOL throughout the study period. Patients treated with ciprofloxacin appeared to experience adverse events at a higher rate (62%) compared to those treated with TMP/SMX (45%) and nitrofurantoin (49%), however the difference was not statistically significant (p = 0.2). CONCLUSION: Patients experiencing cystitis have an increase in their QOL with treatment. Those experiencing clinical cure have greater improvement in QOL compared to patients fail therapy. While QOL is improved by treatment, those reporting adverse events have lower overall QOL compared to those who do not experience adverse events. This study is important in that it suggests that both cystitis and antibiotic treatment can affect QOL in a measurable way.

Sexual function after partial cystectomy and urothelial stripping in a 32-year-old woman with radiation cystitis.

We report a case of a 32-year-old woman who underwent a partial cystectomy to preserve sexual function. After radiotherapy for stage IB1 cervical cancer, cystectomy was indicated because of severe radiation cystitis. During this procedure we resected the upper part of the bladder followed by stripping off urothelium of the remaining bladder to spare the neurovascular bundle. Follow-up after 3 months indicated intact sexual function including orgasm. In our opinion the cystectomy procedure described in this case report is a good, novel option in women who are candidates for cystectomy because of a crippled bladder, after radiotherapy, and want to retain sexual function.

Biofeedback and electrical stimulation therapy for treating urinary incontinence and voiding dysfunction: one center's experience.

Urinary incontinence affects 13 million Americans at a cost of $11.2 billion annually to the community. With an aging population, these numbers are expected to increase substantially in coming years. At the Bladder Control Center in Cincinnati, staff have completed over 3,600 biofeedback sessions with encouraging results.

Environmental influences on viscero(noci)ceptive brain activities: the effects of sheltering.

Visceral disorders are always accompanied by pain and/or a sense of ill-being that entails people to isolate themselves both physically and socially. By analogy with what happens in human beings, we have transferred to the rat the question of whether a protective, dark and quiet environment would influence the brain activities induced by visceral chemically-induced (cyclophosphamide [CP], 100 mg/kg/ip) adverse conditions of life. CP is an antitumoral drug that induces severe side effects (cystitis, headache, nausea, photophobia, phonophobia) and produces a strong state of ill-being in human beings. Brain activities were quantified using the expression of the Fos protein, a molecular marker of neuronal activity. The results compare data from groups of paired animals having been offered a shelter or not. Data were collected 4 h after the injection of CP, i. e., when cystitis was fully developed. Sheltered and unsheltered groups did not differ in bladder pathology. Intentional sheltering was shown to attenuate the expression of the CP-related Fos-Li activity within the locus coeruleus (LC) without affecting that of the structures known preferentially to process nociceptive inputs of bladder origin (dorsal vagal complex, ventrocaudal bulbar reticular formation, nucleus centralis of amygdala, dorsolateral portion of bed nucleus of stria terminalis). The LC levels of tyrosine hydroxylase and galanin neuronal contents were not affected. The LC belongs to the emotional activation system and can respond to a wide range of somatosensory and viscerosensory stimuli. Our hypothesis is that the LC would be processing the nervous activities that accompany the sense of ill-being coming from adverse conditions of life, including visceral disorders, and that voluntary isolation, by reducing its activity, would enable animals to minimize their level of distress.

Peeing barbed wire. Symptom experiences in women with lower urinary tract infection.

OBJECTIVE: To explore the contents and presentation of symptoms experienced by female patients with lower urinary tract infections. DESIGN: Qualitative study based on written answers to open-ended questions on symptom experiences, analysis with Giorgi's phenomenological approach, explanatory model as frame of reference. SETTING: Twelve general practices in the Bergen area of Norway. SUBJECTS: Ninety-four women aged 19-97 years who consulted because they suspected to have an acute cystitis and who had leucocyturia and growth of 10(5) or more uropathogens/ml in the urine. MAIN OUTCOME MEASURES: Descriptions and nuances considered mainstream for cystitis or as a supplement to the traditional medical symptom descriptions. RESULTS: We found a great diversity of symptoms. Typical symptom descriptions were a terrible scorch when the bladder is nearly empty, frequent need to void followed by only a few drops, sometimes so suddenly that it may go wrong, or a constant ache in the low back and belly. Subjects also described constant aching or pressure in the genital area, or they felt miserable and no good in the whole body. Specific symptoms were also localized elsewhere in the body. CONCLUSION: Diverse symptom descriptions complementing previous knowledge were revealed, as well as symptoms not usually mentioned in textbooks or reviews.

Clinical outcome and quality of life after enterocystoplasty for contracted bladders.

From 1989 to 1995, a total of 21 patients underwent enterocystoplasty in order to increase their bladder capacity and decrease intravesical pressure. Of these, 18 had neuropathic bladders caused by spinal cord injuries and 3 had contracted bladders caused by irradiation cystitis following treatment of cervical cancer. Enterocystoplasty was performed using a 40-cm segment of terminal ileum. The postoperative follow-up periods ranged from 6 to 80 months (mean 36 months). Twelve patients, who had had preoperative hydronephrosis, showed complete resolution after enterocystoplasty. Sixteen patients, suffering from intractable urinary incontinence preoperatively, regained continence after surgery while 2 continued to have mild urgent or stress incontinence. Their mean bladder capacities were 165 +/- 97 ml preoperatively and 760 +/- 289 ml postoperatively. The end-filling pressures were 50 +/- 23 cm H2O preoperatively and 13 +/- 4.7 cm H2O postoperatively. Sixteen patients could urinate smoothly, but 12 of them occasionally needed intermittent catheterization in order to evacuate residual urine. Nineteen patients were satisfied with their surgical result, whereas 1 wished to become completely dry, and 1 could not be catheterized because of poor family support. All but 1 of the patients declared that the quality of life improved after surgery. In conclusion, enterocystoplasty is satisfactory treatment for contracted bladders that result in upper tract deterioration or intractable urinary incontinence. Acceptable continence was achieved in 90% of the patients and the overall satisfaction rate was 95%. Careful patient selection is necessary for achieving a good surgical outcome.

Interstitial cystitis. A patient's perspective.

Interstitial cystitis is a debilitating bladder disorder that affects up to 450,000 people in the United States, 90% of whom are women. Confusion in defining and understanding interstitial cystitis has resulted in the failure to diagnose and treat thousands of afflicted patients, committing them to a life of intractable pain. Even with diagnosis, there are no uniformly effective treatments. It is extremely important that these patients have the understanding and support of the medical community, and they should develop a constructive and effective relationship with their physician and other urologic caregivers.

Self-care regimens for patients with interstitial cystitis.

For those who suffer from interstitial cystitis, living with the condition is a challenge that requires creativity, patience, determination, and a sound set of coping mechanisms. Because of the high percentage of gynecologic and systemic manifestations of interstitial cystitis, a customized treatment regimen is often necessary to achieve the therapeutic goal of a remission in symptoms. Treatment philosophies should be based on the proposed causative mechanisms, and a multimodality approach to therapy is usually successful. Self-care regimens give the patient a sense of control by active participation in treatment, which often improves coping mechanisms. Treatment of the sequelae of chronic pain (anxiety and depression) often improves response to overall therapy. Remission is the goal, coping is the key, and creativity opens the door to treating this most perplexing of conditions.

The etiology of interstitial cystitis.

The cause of interstitial cystitis remains unknown. Potential causes including infection, vascular alterations, psychological aberrations, bladder surface alterations, toxic agents, neurologic disorders, and autoimmune responses have been investigated. To date, no compelling evidence for any hypothesized cause is available. Recently, several animal models have been described that may provide a basis for fundamental biologic studies that may aid in answering this important question.

Epidemiology of interstitial cystitis.

This article concerns a survey conducted to determine the origin and history of interstitial cystitis. Information was elicited from 565 patients on demographics, risk factors symptoms, pain, and psychological factors. All those surveyed satisfied the National Institute of Arthritis, Diabetes, Digestive, and Kidney Diseases (NIDDK) criteria for interstitial cystitis and have been diagnosed as having the disorder. Comparison of risk factors was made with a control group of 171 individuals, consisting of healthy individuals over 18 years old and of adults attending urology clinics for bladder disorders unrelated to interstitial cystitis.