RESUMO
For most urologists the decision to operate on a patient with interstitial cystitis is made with extreme caution. The knowledge that this is a nonmalignant disease, that it poses little risk to overall health (although most patients would differ with this assertion), and that surgical intervention may be accompanied by additional complications has relegated open surgical procedures to last on the list of treatments for interstitial cystitis. This reluctance to operate until late in the course of the disease is clearly unsatisfactory. If a successful surgical procedure can performed, it ought to be employed early in the course of the patient's management and not withheld after the unfortunate patient has been subjected to a host of unsatisfactory conservative treatments. There is a need for balance between timidity and surgical aggression in the management of this dreadful condition. There is a need to identify the appropriate patients for surgical treatment and to select the most successful procedure. We should not expect to have to move through a series of different procedures for each patient, but rather select the right one the first time. There is an obvious need for a better understanding of the precise cause and pathogenesis of the condition so that alternative forms of treatment may be investigated. Surgery can provide significant relief for many patients with incapacitating symptoms. Cystectomy, either supratrigonal or total, is best reserved for those patients with markedly reduced bladder capacities.
Assuntos
Cistite/cirurgia , Cistectomia , Humanos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/métodos , Resultado do TratamentoRESUMO
Thirteen patients with interstitial cystitis (IC), whose predominant symptom was pelvic or urethral pain, were treated with a series of lumbar epidural local anaesthetic blocks over an 18-month period. Response was evaluated by interview and with voiding diaries and visual analogue scales (VAS) for pain. Of the 55 injections given, immediate pain relief (lasting longer than 24 h) was obtained from 41 (75%). The duration of subsequent pain relief varied considerably, ranging from 2 to 75 days (mean 15.1). Pain relief was accompanied by significant improvement in sleep habit and quality of life. A good correlation was noted between verbally expressed pain and the recorded VAS pain scores. Urinary frequency and average voided volumes were unaffected by treatment. Two patients failed to obtain any relief. Apart from minor transient backache at the injection site, there were no complications from the procedure. Lumbar sympathetic epidural blockade is an excellent means of providing pain relief in interstitial cystitis.
Assuntos
Cistite/complicações , Bloqueio Nervoso , Manejo da Dor , Adulto , Anestesia Epidural , Cistite/fisiopatologia , Feminino , Humanos , Injeções , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Dor/fisiopatologia , Medição da Dor , Fatores de Tempo , MicçãoRESUMO
Isolated cold stress tests were used to evaluate the thermoregulatory capacity in the feet of 19 patients with interstitial cystitis (IC) and of 11 healthy volunteer control subjects. Mean pedal skin temperature fell more rapidly in the IC group as compared with controls; significant differences were found at 10-min (P = 0.002) and 20-min (P = 0.0008) cooling. Mean skin temperature remained lower in the IC group throughout the study. Sixteen feet (42%) in the IC group and five (22%) of the control feet failed to return to within 2 degrees C of baseline temperature during the 20-min recovery period. These findings may reflect abnormal vasomotor control in the IC group and, if so, may be indicative of increased spinal sympathetic activity in interstitial cystitis.
