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Interstitial cystitis is a syndrome of urinary urgency, frequency and suprapubic pain. We investigated the role of inflammatory mediators in 96 patients with histories and symptoms consistent with interstitial cystitis, and 13 controls from The New York Hospital-Cornell Medical Center, University of Washington and University of California at San Diego. Patients were classified into either group A (meets all criteria of the National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases for inclusion in research studies), group B (meets all of these criteria but without glomerulations) or an "other" group. A small number of group A patients had detectable interleukin-6 in the urine. Urinary concentrations of tumor necrosis factor, prostaglandins E2, D2 and F2 alpha, and thromboxane B2 were not different among either patient groups or controls. Urine specimens contained inhibitors of the bioactivity of interleukin-6 and tumor necrosis factors but no differences between patients or controls were found. No factors chemotactic for human neutrophils were detected in a small patient sample. Bladder wash fluid concentrations of prostaglandins E2, D2 and F2 alpha, and thromboxane were much lower than urinary levels. Bladder wash fluid interleukin-6 and tumor necrosis factor were not detectable. The results suggest that while a small subset of patients may have elevated levels of interleukin-6 the majority of patients do not appear to have elevated levels of inflammatory mediators in the urine or bladder wash fluid. Evaluation of patient bladder tissue may indicate changes not detectable in urine or bladder wash fluid. Alternatively, other etiologies must be considered in those patients.
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PMID:Inflammatory mediator profile in urine and bladder wash fluid of patients with interstitial cystitis. 801 71

Bladder permeability was directly measured with the radionuclide used clinically for detecting vesicoureteral reflux (99mtechnetium-diethylenetriaminepentaacetic acid, 99mTc-DTPA) in 10 interstitial cystitis patients diagnosed according to National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases criterion and compared to 9 sex matched, symptom-free, normal volunteers. After functional bladder capacity was determined (capacity at which the patient demands fluid inflow to stop), the bladder was emptied and 5 mCi. 99mTc-DTPA in 10 ml. of saline were infused followed by normal saline to 80% of functional capacity. This was done to normalize the patients to the same low bladder pressure, since previous studies of rabbits indicated that bladder permeability is low and not significantly different at 20% and 60% of anesthetized bladder capacity (defined as the volume producing an intravesical pressure of 20 cm. water). Radioactivity of 1 ml. serum specimens taken at 0, 2, 15 and 30 minutes after radionuclide infusion was determined in a gamma counter, corrected for radioactive decay and converted to per cent of instilled dose per whole body based on blood volume estimated from body weight for each individual. There was considerable interindividual variability in the absorption between the patients and the volunteers. Analysis of variance of these data showed no statistically significant difference between the patients and controls at any time sampled. These results indicate that while some interstitial cystitis patients have a more permeable bladder than others, the same is true for normal, symptom-free volunteers. Thus, the concept of increased bladder permeability in interstitial cystitis is not supported by this direct measurement of bladder permeability.
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PMID:Bladder permeability in interstitial cystitis is similar to that of normal volunteers: direct measurement by transvesical absorption of 99mtechnetium-diethylenetriaminepentaacetic acid. 828 23

The diagnosis of interstitial cystitis is best based on the techniques necessary to elicit the criteria established at the conferences of the National Institute of Arthritis, Diabetes, Digestive, and Kidney Diseases (NIDDK). Essentially, this requires a thorough patient history, urodynamic evaluation, and cystoscopy carried out under anesthesia with hydrodistention of the bladder and bladder biopsy. Diagnosis of interstitial cystitis is tightly linked to its definition, and until the latter is crystal clear, the former will continue to be murky.
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PMID:Diagnosis of interstitial cystitis. 828 46

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.
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PMID:Epidemiology of interstitial cystitis. 828 48

A bladder disorder of unknown etiology, interstitial cystitis affects mainly women, and its prevalence may be increasing. Little information is available on the demographic, clinical, diagnostic, and treatment aspects of interstitial cystitis in the minority population. This retrospective review of the patient database at the Interstitial Cystitis Center, New England Medical Center, identified 17 minority women among a total of 201 patients who satisfied the criteria of the National Institutes of Health's National Institute of Diabetes and Digestive and Kidney Diseases for diagnosis of interstitial cystitis. Minority women accounted for 8.5% of the patients, with 3% being African American; 3.5%, Hispanic American; and 2.0%, Asian American. The clinical and endoscopic findings as well as responses to treatment were similar in both the minority and nonminority populations. However, the average duration of symptoms prior to diagnosis was 2.9 years in the minority group, compared with an average of 13 months in the nonminority group. Minority women with interstitial cystitis appear to be symptomatic for longer periods before a definitive diagnosis is made. Their response to treatment parallels that of the nonminority population. Further studies are needed to address the natural history, urologic referral patterns, and treatment outcomes in minority women who have interstitial cystitis.
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PMID:Interstitial cystitis in minority women. 836 21

Demonstration of adherence of Tamm-Horsfall protein to bladder epithelium has been suggested as a potential diagnostic test for interstitial cystitis. Bladder specimens from 18 interstitial cystitis patients were evaluated by indirect immunoperoxidase techniques using a Tamm-Horsfall protein specific monoclonal antibody to determine the diagnostic value of the staining results. The study population consisted of 7 severely diseased patients who required cystectomy with urinary diversion and 11 other patients meeting National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases criteria for interstitial cystitis. We were unable to detect intraepithelial or surface-bound Tamm-Horsfall protein in any of the biopsy tissues. Human kidney tissue, similarly fixed and processed, consistently demonstrated Tamm-Horsfall protein staining of the kidney tubules. The monoclonal antibody also reacted on Western blots against urinary Tamm-Horsfall protein. Although antibody (alpha-Tamm-Horsfall protein) reactivity was measured by enzyme-linked immunosorbent assay in sera from interstitial cystitis patients, the titers did not differ statistically from those measured in sera from those without interstitial cystitis. Together, these results make it unlikely that immunohistochemical detection of Tamm-Horsfall protein will have diagnostic value in interstitial cystitis. Whether Tamm-Horsfall protein has a role in the pathogenic processes involved in this disease is not yet known. These findings do not eliminate the possibility that some interstitial cystitis patients will have abnormalities associated with the biochemical and physiological functions of Tamm-Horsfall protein.
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PMID:Evaluation of urothelial Tamm-Horsfall protein and serum antibody as a potential diagnostic marker for interstitial cystitis. 841 10

A survey directed at determining the natural history of interstitial cystitis was conducted at our clinic. Information on demographics, risk factors, symptoms, pain and psychosocial factors was elicited from 374 patients who satisfied the National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases criteria for interstitial cystitis and had all been diagnosed as having interstitial cystitis by a urologist. With regard to demographics, patients were predominantly female (89.8%) and white (94.1%), with a mean age of 53.8 +/- 0.7 years (standard error) and age at the first symptoms of 42.5 +/- 0.8 years. Information on 25 potential risk factors included 44.4% of the women reporting hysterectomy, 38.2% of the patients having strong sensitivities or allergic reactions to medication and only 2.7% being diabetic. With regard to interstitial cystitis symptoms, frequency and urgency were reported by 91.7% and 89.3% of the patients, respectively, while pelvic pain, pelvic pressure and bladder spasms were reported by more than 60% of respondents and burning by 56%. Location and degree of pain were also reported. Urination relieved or lessened interstitial cystitis pain for 73.6% of the patients and medication was effective for 46.8%. Other behaviors (for example hot baths, heating pads, lying down or sitting) were less effective. Conversely, stress, constrictive clothing and intercourse increased interstitial cystitis pain in more than 50% of the patients. In addition, acidic, alcoholic or carbonated beverages, and coffee or tea increased interstitial cystitis pain in more than 50% of the patients. More than 60% of the patients were unable to enjoy usual activities or were excessively fatigued and 53.7% reported depression. Travel, employment, leisure activities and sleeping were adversely affected in more than 80% of the patients. Pain location and degree differed significantly between patients with and without ulcers in the bladder. In addition, there was an apparent plateau in the frequency and urgency among patients after approximately 5 years with symptoms.
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PMID:The natural history of interstitial cystitis: a survey of 374 patients. 843 48

Laser doppler flowmetry was used to study bladder blood flow in 16 patients with interstitial cystitis and in 18 control subjects. All studies were performed at cystoscopy under general anesthesia. Interstitial cystitis patients conformed to the diagnostic criteria of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Blood flow measurements were made at four specific sites in the bladder at a capacity of 100 ml. and at full capacity. The mean maximum capacity under anesthesia was 828 cc for the control group and 562 cc for the IC group. Blood flow at low capacity was similar in the two groups. When the bladder was filled to capacity, blood flow increased by a mean of 9.05 LDF units in the control group but only by 0.06 LDF units in the IC group (p = 0.007). Vault perfusion increased considerably more in the control group compared to the IC group (p = 0.002). The mean ratio of vault to trigonal perfusion was similar in both groups and was not affected by the overall blood flow changes which accompanied distension. Although the mean bladder capacity under anesthesia was greater in the control group, covariant analysis showed that the significant differences in perfusion between the two groups occurred independently of changes in capacity. It is concluded that bladder perfusion at capacity is significantly impaired in interstitial cystitis.
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PMID:Impaired bladder perfusion in interstitial cystitis: a study of blood supply using laser Doppler flowmetry. 845 69

In October 2000, the National Institute of Diabetes and Digestive and Kidney Diseases and the Interstitial Cystitis Association held a joint meeting in Minneapolis, Minnesota. Clinical highlights from this meeting are reviewed. The general state of interstitial cystitis from the vantage point of the clinician is discussed, as well as epidemiologic advances, new concepts in markers for interstitial cystitis, and new treatment strategies. Although there are no breakthroughs in finding a cure for this disorder, potential major changes in methods of diagnosis and new forms of therapy are in the offing.
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PMID:Clinical highlights of the National Institute of Diabetes and Digestive and Kidney Diseases/Interstitial Cystitis Association scientific conference on interstitial cystitis. 1137 41

Our objective was to determine whether there is a greater concordance of interstitial cystitis (IC) among monozygotic than dizygotic twins. Members of the Interstitial Cystitis Association (ICA) who responded to a survey about first-degree family members with IC symptoms or confirmed IC were requested to identify themselves if they were 1 of a twin pair. Each twin respondent and co-twin were then evaluated via a questionnaire and acquisition of hydrodistention reports as to their meeting modified National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) criteria for IC. Of the co-twins of 8 monozygotic twin respondents, 2 had probable and 3 had confirmed IC compared with none of the co-twins of the 26 dizygotic twin respondents (including 15 female co-twins). There is a greater concordance of IC among monozygotic than dizygotic twin pairs suggesting a genetic susceptibility to IC.
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PMID:Concordance of interstitial cystitis in monozygotic and dizygotic twin pairs. 1137 45


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