Effect of comestibles on symptoms of interstitial cystitis.

PURPOSE: Anecdotal evidence suggests that patients with painful bladder syndrome/interstitial cystitis report symptom exacerbation after consuming particular foods, beverages and/or supplements. We determined the prevalence of the effect of comestibles on painful bladder syndrome/interstitial cystitis symptoms and identified particular comestible items more likely to affect such symptoms. MATERIALS AND METHODS: A validated questionnaire designed to detect whether food, beverages and/or supplements have an effect on bladder symptoms was administered to 104 patients meeting National Institute for Diabetes and Digestive and Kidney Diseases criteria for interstitial cystitis. In addition to answering general questions about the effect of comestibles on painful bladder syndrome/interstitial cystitis symptoms, subjects were asked to indicate whether each of 175 individual items worsened, improved or had no effect on symptoms. Each response was numerically scored on a scale of -2 to 2 and mean values were generated for each comestible item. RESULTS: Of the surveyed patients with painful bladder syndrome/interstitial cystitis 90.2% indicated that the consumption of certain foods or beverages caused symptom exacerbation. There was no correlation between allergies and the effect of comestibles on symptoms. Patients who reported that specific foods worsened symptoms tended to have higher O'Leary-Sant interstitial cystitis symptom index and problem index, and/or pelvic pain and urgency/frequency patient symptom scale scores. A total of 35 comestible items had a mean score of lower than -1.0, including caffeinated, carbonated and alcoholic beverages, certain fruits and juices, artificial sweeteners and spicy foods. CONCLUSIONS: There is a large cohort of patients with painful bladder syndrome/interstitial cystitis in whom symptoms are exacerbated by the ingestion of specific comestibles. The most frequently reported and most bothersome comestibles were coffee, tea, soda, alcoholic beverages, citrus fruits and juices, artificial sweeteners and hot pepper.

Analysis of outcomes of single polypropylene mesh in total pelvic floor reconstruction.

AIMS: A 2.5-year outcome analysis was performed on patients who underwent transvaginal repair of total pelvic organ prolapse with single polypropylene mesh. A description of the repair technique using a tension-free 4-point fixation is also reviewed. METHODS: After proper vaginal dissection, a specially fashioned "H" shaped polypropylene mesh is positioned and fixed at 4-points. With a single piece of mesh, the anterior arms provide mid-urethral and bladder neck support, the mid-portion of the mesh corrects anterior compartment defects, and the posterior arms aid in vaginal vault suspension. Initially, bone anchors were utilized for anterior fixation, but currently a tension-free method is used. A retrospective analysis using chart review was performed on 96 patients who underwent this procedure from January 2000 to June 2005. Additional information was gathered by a telephone survey using a questionnaire. Statistical analysis was performed using Student's t-test, with Sigma Stat(R). RESULTS: Seventy-six patients (79%) were available with a mean follow-up time of 30.7 +/- 1.7 months and mean age of 69.3 +/- 11.3. Among those with follow-up, 36 patients (47.4%) underwent concurrent hysterectomies. Recurrence of prolapse was reported by four patients (5.2%). Sixty-eight patients (89%) were completely dry or almost dry, defined as an occasional leak. For those with preoperative incontinence (n = 36), average pad use per day decreased significantly from 2.1 +/- 0.4 to 0.8 +/- 0.2 (P < 0.005) postoperatively. Twelve patients (15.7%) reported of de novo urgency. Six patients required reoperation including excision of vaginal mesh erosion (2), uretholysis for obstruction (1), removal of palpable vaginal suture (1), and recurrent SUI (2). Among the 21 patients who are sexually active, 19 denied any dyspareunia (90.4%). Patient satisfaction was high, as the mean value was 7.9 +/- 0.3 on a scale of 1 (least satisfied) to 10 (most satisfied). CONCLUSIONS: Transvaginal repair of complete pelvic prolapse using polypropylene mesh is a safe and efficacious option, with minimal recurrence of prolapse and SUI. While two patients had vaginal erosions, no urethral or bladder erosions occurred. Patient satisfaction was overall favorable.

Efficiency of questionnaires used to screen for interstitial cystitis.

PURPOSE: Questionnaires for the evaluation of interstitial cystitis are widely used, but their value in discriminating interstitial cystitis from other diagnoses among patients with urological symptoms has not been determined. We assessed the validity of 2 frequently used interstitial cystitis questionnaires-the O'Leary-Sant Symptom Index and Problem Index and the Pain, Urgency, Frequency Symptom Scale-for screening for interstitial cystitis. MATERIALS AND METHODS: The Pain, Urgency, Frequency Symptom Scale and the O'Leary-Sant Symptom Index and Problem Index were administered to the same 220 patients at a urology clinic before diagnosis. Questionnaire scores between patients with and without interstitial cystitis, as well as among diagnostic groups, were compared by parametric and nonparametric analyses. Receiver operating characteristic curves were constructed to determine the efficiency of each questionnaire in discriminating between patients with and without interstitial cystitis. RESULTS: Interstitial cystitis was distinguishable from the other diagnoses using both questionnaires (p <0.001). Separate analyses of bother and symptom scores yielded similar results. Receiver operating characteristic curves demonstrated the Pain, Urgency, Frequency Symptom Scale to be more efficient than the O'Leary-Sant Symptom Index and Problem Index in detecting interstitial cystitis in this population with an optimal cutoff value of 13 or greater. CONCLUSIONS: While the Pain, Urgency, Frequency Symptom Scale and the O'Leary-Sant Symptom Index and Problem Index questionnaires distinguish interstitial cystitis from other urinary tract pathologies, neither questionnaire demonstrates sufficient specificity to serve as the sole diagnostic indicator. These questionnaires should not be used to define interstitial cystitis, but can be used to screen patients with urinary tract symptoms to identify those who should be further examined for interstitial cystitis or to follow those who have already been diagnosed.

Effects of pneumoperitoneal gases and pressures on transitional cell carcinoma adhesion, growth, apoptosis and necrosis: an in vitro study.

PURPOSE: We studied the effects of insufflation gas and pressure on the adhesion, growth, apoptosis and necrosis of transitional cell carcinoma (TCC) in an in vitro model. MATERIALS AND METHODS: Tumor adhesion and cell growth of AY-27 rat TCC was measured after 3-hour incubation with CO2, N2 and He insufflation at different pressures (0, 10 and 15 mm Hg) in vitro. The effects of these gases on the rate of tumor cell apoptosis and necrosis were compared. RESULTS: In vitro the tumor adhesion rate was lowest with CO2 and highest with N2. Higher gas pressures resulted in decreased adhesion rates for CO2 and He but increased adhesion rates for N2. N2 enhanced tumor cell proliferation at all pressures studied. He and CO2 resulted in an initial increase in cell proliferation in the first 24 hours, followed by a decrease in tumor growth. Extracellular medium turned acidic in CO2 (pH 6.27 to 6.39) but basic in N2 and He (pH 8.39 to 8.84). At all insufflation pressures studied apoptosis and necrosis rates were increased in the first 24 hours, followed by a decrease for CO2 and N2. He resulted in increasing apoptosis and necrosis throughout the study period. CONCLUSIONS: The type of gas and insufflation pressure affects cell adhesion and tumor growth. There was a significant increase in tumor adhesion and proliferation with N2 insufflation compared with CO2 and He at 0 to 15 mm Hg pressures. CO2 demonstrated the greatest decrease in TCC adhesion and proliferation at 15 mm Hg pressure. Apoptosis and necrosis were highest for He compared with the other gases.

Synthetic biomaterials for pelvic floor reconstruction.

Pelvic organ prolapse and stress urinary incontinence increase with age. The increasing proportion of the aging female population is likely to result in a demand for care of pelvic floor prolapse and incontinence. Experimental evidence of altered connective tissue metabolism may predispose to pelvic floor dysfunction, supporting the use of biomaterials, such as synthetic mesh, to correct pelvic fascial defects. Re-establishing pelvic support and continence calls for a biomaterial to be inert, flexible, and durable and to simultaneously minimize infection and erosion risk. Mesh as a biomaterial has evolved considerably throughout the past half century to the current line that combines ease of use, achieves good outcomes, and minimizes risk. This article explores the biochemical basis for pelvic floor attenuation and reviews various pelvic reconstructive mesh materials, their successes, failures, complications, and management.

Collagen synthesis is not altered in women with stress urinary incontinence.

AIMS: The objective of this study was to demonstrate that weakened pelvic floor support of the lower genitourinary tract in women with stress urinary incontinence (SUI) is due, in part, to decreased collagen synthesis and secretion and/or an altered ratio of collagen III/I synthesis by the fibroblasts of the endopelvic fascia and skin compared to that of women without evidence of pelvic floor weakening. METHODS: Endopelvic fascia and skin biopsies were obtained from women with SUI (n = 14) and women without evidence of SUI or genital prolapse (n = 12). Fibroblast cultures established from the biopsies were incubated with 3H-proline in medium containing ascorbic acid for 3 hr. Conditioned medium was collected and cells were harvested. The radiolabeled collagens were precipitated and digested with collagenase. The collagen synthesized (as a percent of total protein) was determined. Collagen alpha1(III) was separated from collagen alpha1(I) and alpha2(I) by interrupted SDS-PAGE and the amount of (3)H-proline in each band was determined. RESULTS: Collagen synthesis, expressed as percent of total protein synthesis, was not significantly different between fibroblasts obtained from women with or without SUI. The mean of collagen III/I synthesized in fibroblasts was not significantly different between fibroblasts obtained from women with or without SUI. CONCLUSIONS: These data suggest that the lower collagen content in the endopelvic fascia and skin of women with SUI is not due to reduced collagen synthesis or selective reduction in synthesis of either collagen I or collagen III, compared to women without pelvic floor weakening.

Excretion of collagen derived peptides is increased in women with stress urinary incontinence.

AIMS: The objective of this study was to demonstrate that weakened pelvic floor support of the lower genitourinary tract in women with stress urinary incontinence (SUI) is due to increased collagenolysis. When fibrillar collagen is degraded, pyridinium (PYD) crosslinks are released and excreted in the urine. Degradation of collagen also results in peptide fragments of various lengths which are excreted in the urine. Degradation of mature fibrillar collagen and collagen which has not been crosslinked can be assessed independently by measurement of both PYD and collagen-derived peptides in the urine. METHODS: Twenty-four hour urine collections were obtained from women with SUI (n = 23) and women without urinary incontinence (n = 39). Urinary PYD concentration was assayed by ELISA. The urinary concentration of helical peptide alpha1 (I) 620-633 fragments derived from collagen was assayed by competitive enzyme immunoassay. Values were normalized to creatinine. RESULTS: The mean urine PYD concentration for women with SUI (110.8 +/- 19.7 nM/mM creatinine) was not significantly different than that for women without SUI (85.2 +/- 13.7 nM/mM creatinine). The mean urine concentration of helical peptide alpha1 (I) 620-633 for women with SUI (0.80 +/- 0.13 microg/mg creatinine) was significantly (P < 0.02) higher than that for women without SUI (0.49 +/- 0.06 microg/mg creatinine). CONCLUSIONS: These data suggest that collagenolytic activity in women with SUI is elevated compared to continent controls, as measured by urinary helical peptide alpha1 (I) 620-633 excretion. The lack of difference in urinary PYD excretion between the two populations suggests that the increased collagenolytic activity in women with SUI, compared to continent controls, is restricted to uncrosslinked collagen.

A comparison of multiple urine markers for interstitial cystitis.

PURPOSE: We measured several urine markers in 24-hour specimens from patients with interstitial cystitis and healthy controls. For each marker we determined whether the urine level was significantly different in interstitial cystitis and control cases, and whether the marker level correlated with the symptom score. MATERIALS AND METHODS: Study participants included 36 female patients with interstitial cystitis and 36 age matched female volunteers. Multiple urine aliquots were obtained to measure the various markers. RESULTS: Certain markers were significantly increased in interstitial cystitis, including anti-proliferative factor, epidermal growth factor, insulin-like growth factor (IGF) binding protein-3 and interleukin (IL)-6. Markers significantly decreased in interstitial cystitis were heparin-binding epidermal growth factor-like growth factor, cyclic guanosine monophosphate and methylhistamine. Other markers were not significantly different in the interstitial cystitis and control groups, including total glycosaminoglycans, epitectin, hyaluronic acid, IL-8, IL-1 and nitrates plus nitrites. IGF-1 was undetectable in 24-hour urine samples but spot voided samples from the same interstitial cystitis population had IGF-1 levels similar to previously reported levels. The only significant association of marker with symptom score was a positive correlation of IL-6 with nocturia. For all markers the conclusions were the same whether the marker was normalized to creatinine or to 24 hours. CONCLUSIONS: This study confirmed several previously reported urine alterations in interstitial cystitis, including increased anti-proliferative factor, epidermal growth factor, IGF binding protein-3 and IL-6, and decreased heparin-binding epidermal growth factor-like growth factor and cyclic guanosine monophosphate. Of all markers studied anti-proliferative factor had the least overlap in the interstitial cystitis and control groups, and so it is the most likely candidate to become a diagnostic test.

Effects of Salts, Sugars, and Salt-Sugar Combinations on Growth and Sporulation of an Isolate of Eurotium rubrum from Pancake Syrup.

An osmoduric-saccharophilic fungus, identified as a strain of Eurotium rubrum Konig, Speikermann and Bremer and isolated from a bottle of syrup, showed optimum growth (i.e., increase in colony diameter) on Sabouraud's agar amended with 60% (w/v) sucrose (calculated aw = 0.964) and still grew near optimally at 110% (aw = 0.927). On glucose, fructose or arabinose, optimum growth occurred at 40% (w/v) (aw = 0.962, 0.962, and 0.954, respectively), but glucose supported better growth than did fructose or arabinose. In the presence of glycerol, optimum growth (i.e., increase in dry weight of mycelium) occurred at a 10% (v/v) concentration (aw = 0.972) and no growth occurred above 35% (aw = 0.878). In general, growth was better with 12-C > 6-C > 5-C > 3-C compounds. The fungus did not grow on concentrations of inorganic salts above 30%; growth on salts was best with (on a w/v basis) 10% KCl (aw = 0.957), 5% NaCl (aw = 0.972) or 10% CaCl2, (aw = 0.965). In the absence of either organic or inorganic solutes, there was essentially no growth. When sucrose and either KCl or NaCl were added together, growth was greater on a salt/sugar mixture than on the same concentration of salt alone, and, at equivalent calculated osmotic pressures and aw, sucrose alone supported better growth than did any salt/sugar mixture. These data indicate that the fungus has a requirement for, and a tolerance to, high solute concentrations. At equivalent osmotic pressures and aw, however, sugars supported greater growth than did inorganic salts.