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Vaginal Lawsuit: Bladder retraining is widely used to treat many of the disorders giving rise to symptoms of urinary frequency-urgency, including DO and sensory urgency. The patient is taught to slowly increase the interval between voiding episodes so that frequency can be reduced and the functional cystometric capacity increases. This technique was used by Oarvis to treat women with sensory urgency. He demonstrated that >50% of these women were symptom-free and objectively dry six months after treatment with bladder retraining.
This chronic inflammatory disorder of the bladder is notoriously difficult to manage and can result in considerable morbidity. Quality-of- life scores in women with IC are consistently low. Women between the ages of 40 and 60 years are most commonly affected. The condition occurs far more frequently in Caucasians and there is a 9:1 female predominance.4 Reported prevalence rates for this condition vary widely as there is no universally accepted definition.
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Avoiding often relieves the suprapubic discomfort, and drinking alcohol and caffeine- containing drinks frequently exacerbates the pain. In an attempt to standardize diagnosis, the National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases published consensus criteria in 1988. These consist of a list of exclusion criteria together with some positive cystoscopic features (Table 9.2). There is no universally agreed histological standard for diagnosing IC on bladder biopsy. However, biopsies are useful to exclude other pathology, including malignancy.
Many different treatments have been tried for IC, with little sustained success. Proposed systemic treatments include antihistamines, heparin, amitriptyline and pentosan polysulphate. Pentosan polysulphate is a synthetic glycosaminoglycan analogue and augments the protective mucous layer of the bLadder. Many patients with IC have been shown to have an improvement in symptoms following cystodistension. Unfortunately, any beneficial effects are short-lived. The treatment with the most evidence to support its use is instillation therapy with dimethyl sulphoxide (DMSO, an industrial solvent). The treatment regimen is easy and inexpensive to perform on an outpatient basis, providing the patient can manage to self- catheterize. A significant improvement can be expected in over 50% of patients with early IC.
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In a small Danish follow-up study over three years, monthly instillation of sodium hyaluronate solution (Cystistat, Pliva Pharma) showed benefit in approximately two-thirds of cases, and apparent recovery in 20%.6Furthermore, in a study of refractory cases of IC, an initial positive response in 56% at four weeks improved to 71% by week 12. Response then decreased after week 24 of treatment. King’s College Hospital is currently part of an international multicentre study to assess the safety and efficacy of pelvic floor electrostimulation in the treatment of IC. Although the results are awaited, the initial response appears very encouraging.
Finally, where other treatments fail and symptom severity is such that the patient’s quality-of-life is destroyed, a urological opinion should be sought and reconstructive surgery considered. Sensory urgency is a diagnosis of exclusion made after urodynamic assessment. It consists of the symptom complex of frequency-urgency, and occasionally urge incontinence, but with no evidence of DO on subtracted cystometry or other underlying intravesical pathology.
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