Does mast cell density predict the outcome after transurethral resection of Hunner's lesions in patients with type 3C bladder pain syndrome/interstitial cystitis?

OBJECTIVE: This study aimed to assess mast cell density in the lamina propria for possible correlation with duration of symptom amelioration after transurethral resection of the bladder (TURB). MATERIAL AND METHODS: Twelve patients (eight women and four men) referred to the tertiary referral facility, treated between June 2003 and June 2009, were included in the study. All had undergone three consecutive complete TURB procedures, where the first one was also diagnostic. All patients fulfilled the NIH-NIDDK criteria and the ESSIC bladder pain syndrome/interstitial cystitis type 3C criteria; they had Hunner's lesions and biopsy findings with inflammatory infiltrates, granulation tissue and mastocytosis. Bladder biopsies were evaluated for mast cell density by immunochemistry and symptom amelioration was recorded by self-report of symptom relapse. RESULTS: Median mast cell density in the lamina propria at the first, second and third TURB was high. No statistically significant correlation between mast cell density in the urothelium, lamina propria or detrusor, and duration of symptom amelioration could be seen after the first, second or third TURB. CONCLUSION: Mast cell density does not appear to correlate with duration of symptom amelioration after complete transurethral resection of Hunner's lesions, either in the lamina propria or in the urothelium or detrusor.

Long-term results of reconstructive surgery in patients with bladder pain syndrome/interstitial cystitis: subtyping is imperative.

OBJECTIVES: To evaluate the long-term outcome after reconstructive surgery in patients with bladder pain syndrome/interstitial cystitis subdivided into subtypes. METHODS: A total of 47 patients, fulfilling the National Institutes of Health/National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases criteria, were evaluated retrospectively. They all had undergone reconstructive surgery during the 25-year period of 1978 to 2003. The surgical procedures included noncontinent ureteroenterocutaneostomy (12 patients), supratrigonal cystectomy and ileocystoplasty (23 patients), continent urinary diversion (Kock pouch; 10 patients), continent orthotopic diversion (1 patient), and cecocystoplasty (1 patient). The series comprised 34 patients with classic Hunner type disease and 13 patients with nonulcer bladder pain syndrome/interstitial cystitis. The patients were preoperatively assessed by interview, visual analog pain scale, micturition diaries, urinalysis, intravenous urography, urethrocystoscopy, and bladder distension during anesthesia, including biopsy and, in selected cases, urodynamic evaluation. The data were obtained by surveying the clinical records. RESULTS: For 28 of the 34 patients with classic Hunner-type disease, the initial surgical procedure resulted in complete symptom resolution. Of the remaining 6 patients, 4 were successfully treated with a supplementary diversion procedure, cystectomy, or transurethral ulcer resection in the trigonal remnant. In contrast, only 3 of the 13 patients with nonulcer disease experienced symptom resolution after reconstructive surgery, and 2 of these required a supravesical diversion procedure. CONCLUSIONS: Reconstructive surgery for refractory bladder pain syndrome/interstitial cystitis is an appropriate last resort only for patients with end-stage Hunner's disease. The decision to embark on major reconstructive surgery in patients with bladder pain syndrome/interstitial cystitis should be preceded by a thorough preoperative evaluation, with emphasis on assessment to determine the relevant subtype (ie, classic or nonulcer disease).

Critical appraisal of dimethyl sulfoxide treatment for interstitial cystitis: discomfort, side-effects and treatment outcome.

OBJECTIVE: To evaluate the discomfort and long-term efficacy associated with instillation of dimethyl sulfoxide (DMSO). MATERIAL AND METHODS: A total of 28 patients, 13 (11 females, 2 males) with classic interstitial cystitis (IC) and 15 (13 females, two males) with non-ulcer disease, who had received at least one series of six instillations of DMSO were studied. In addition to studying micturition diaries before and after the treatment, the evaluation included assessments of pain using a visual analog scale and of side-effects after each instillation in every series. Data were obtained by surveying the clinical records. A follow-up telephone interview was conducted for those patients who were treated with DMSO and in whom the treatment was considered successful. DMSO instillations were considered successful if the patient reported symptom amelioration and chose to continue with the treatment. RESULTS: Side-effects were not more common or pronounced in patients with classic compared to non-ulcer IC. For classic IC a significant difference could be seen when comparing side-effects experienced during the first three instillations and the three subsequent instillations. After DMSO instillations, a residual treatment effect lasting 16-72 months could be seen. CONCLUSIONS: Intravesical instillation therapy with DMSO appears to be a feasible treatment option for both subtypes of IC and is associated with a reasonably low degree of discomfort.

[Treatment pattern and results in an outpatient population with type 2 diabetes in Iceland.].

AIMS: Type 2 diabetes mellitus is a major health problem all over the world. The prevalence of the disease is increasing markedly. Healthcare cost associated with type 2 diabetes is high and the long-term diabetic complications account for the greatest proportion of direct cost. Effective control of blood glucose, lipids and blood pressure can delay the development of complications. The purpose of this study was to examine the risk factors, treatment pattern and results in an Icelandic outpatient population with type 2 diabetes. Our results were compared especially with results from Sweden. MATERIAL AND METHODS: Charts were reviewed for all patients (906) with type 2 diabetes that attended the Diabetes Outpatient Clinic at the University Hospital of Iceland in the year 2001. Information about clinical characteristics for the year 2002 were prospectively reviewed for the 380 patients from the year before and for 121 newly diagnosed patients. Clinical characteristics included were age, sex, diabetes duration, glycemic control (HbA1c), office blood pressure, body mass index (BMI), smoking habits, use of lipid- and blood pressure lowering drugs, diabetes treatment and diabetic retinopathy. RESULTS: Mean age was 66 +/-13.1 (SD) years and the mean age at diagnosis was 57 +/-13.1 (SD) years. Sixty percent were men. The mean body mass index was 29.7 kg/m(2). About 85% of patients had body mass index >25 which is much higher than in 1987 when this proportion was about 67.3%. Mean HbA1c was 7.02 the year 2001 and 6.94% in 2002. The mean cholesterol level was 5.44 mmol/L, HDL 1,22 mmol/L and LDL 3.17 mmol/L in 2002 and 27% were taking lipid lowering drugs in 2002. More patients (61%) reached the blood pressure goal 140/80 mmHg during 2002 than the year before (55%). Sixty five percent were using oral hypoglycemic agents and 17,4% insulin alone. Prevalence of smoking was 13% and of retinopathy 17.1%. CONCLUSIONS: The mean body mass index has been increasing in Iceland as in other western countries. In our survey the mean glycosylated hemoglobin of 7% is somewhat lower than in comparable European surveys, indicating a better glycemic control here. However our survey and comparable surveys indicate that treatment of dyslipidemia and blood pressure has to be more aggressive.