Advertisement

Intravesical Therapy and Its Evolution Over Three Decades, A European View

  • Mauro CervigniEmail author
Chapter
  • 466 Downloads

Abstract

The finding of an effective and specific therapy for IC/BPS remains a challenge because of the lack of a consensus regarding the causes and the inherent difficulties in the diagnosis. One of the last recent hypothesis is that IC/BPS could be pathophysiologically related to a disruption of the bladder mucosa surface layer with consequent loss of glycosaminoglycans (GAGs). This class of mucopolysaccharides has hydrorepellent properties and their alteration expose the urothelium to many urinary toxic agents (GAGs). The urothelium consist of three layers of cells [1–3] (basal, intermediate and apical or umbrella cells) This outer layer comprises the main impermeable and protective barrier against urine. The barrier function is comprised also of other defensive mechanism such as: tight junctions, uroplakin and a dense layer of glycosaminoglycan (GAG) on the apical surface. The removal of GAG layer causes loss of the apical cells within 24 h and leads to enhanced permeability. When these substances penetrate the bladder wall a chain is triggered in the submucosa. Here nerve terminals produce inflammatory mediators causing mast cell degranulation and histamine secretion with consequent vasodilatation and inflammatory exudate. The consequence of this inflammatory response is the stimulation of C fibers with mast cell activation and histamine release. This produce consequent bladder pain and release of neuropetides with a consequent damage to the mucosa and fibrosis of the submucosa [4–6].

References

  1. 1.
    Hicks RM, Ketterer B, Warren RC. The ultrastructure and chemistry of the luminal plasma membrane of the mammalian urinary bladder: a structure with low permeability to water and ions. Philos Trans R Soc Lond Ser B Biol Sci. 1974;268:23–38.CrossRefGoogle Scholar
  2. 2.
    Congiu T, Radice R, Raspanti M, et al. The 3D structure of the human urinary bladder mucosa: a scanning electron microscopy study. J Submicrosc Cytol Pathol. 2004;36:45–53.PubMedGoogle Scholar
  3. 3.
    Jost SP, Gosling JA, Dixon JS. The morphology of normal human bladder urothelium. J Anat. 1989;167:103–15.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Bassi P, Costantini E, Foley S, et al. Glycosaminoglycan therapy for bladder diseases: emerging new treatments. Eur Urol. 2011;10:451–9.CrossRefGoogle Scholar
  5. 5.
    Iavazzo C, Athanasiou S, Pitsouni E, et al. Hyaluronic acid: an effective alternative treatment of interstitial cystitis, recurrent urinary tract infections, and hemorrhagic cystitis? Eur Urol. 2007;51:1534–40. discussion 1540-1CrossRefPubMedGoogle Scholar
  6. 6.
    Parsons CL. Prostatitis, interstitial cystitis, chronic pelvic pain, and urethral syndrome share a common pathophysiology: lower urinary dysfunctional epithelium and potassium recycling. Urology. 2003;62:976–82.CrossRefPubMedGoogle Scholar
  7. 7.
    Hauser PJ, Buethe DA, Califano J, et al. Restoring barrier function to acid damaged bladder by intravesical chondroitin sulfate. J Urol. 2009;182:2477–82.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Engles CD, Hauser PJ, Abdullah SN, et al. Intravesical chondroitin sulfate inhibits recruitment of inflammatory cells in an acute acid damage “leaky bladder” model of cystitis. Urology. 2012;79:483.e13–7.CrossRefGoogle Scholar
  9. 9.
    Hurst RE. Structure, function, and pathology of proteoglycans and glycosaminoglycans in the urinary tract. World J Urol. 1994;12:3–10.CrossRefPubMedGoogle Scholar
  10. 10.
    Fall M, Baranowski AP, Elneil S, et al. EAU guidelines on chronic pelvic pain. Eur Urol. 2010;57:35–48.CrossRefPubMedGoogle Scholar
  11. 11.
    Parsons CL. The therapeutic role of sulfated polysaccharides in the urinary bladder. Urol Clin North Am. 1994;21:93–100.PubMedGoogle Scholar
  12. 12.
    Parsons CL, Forrest J, Nickel JC, et al. Effect of pentosan polysulfate therapy on intravesical potassium sensitivity. Urology. 2002;59:329–33.CrossRefPubMedGoogle Scholar
  13. 13.
    Davis EL, El Khoudary SR, Talbott EO, et al. Safety and efficacy of the use of intravesical and oral pentosan polysulfate sodium for interstitial cystitis: a randomized double-blind clinical trial. J Urol. 2008;179:177–85.CrossRefPubMedGoogle Scholar
  14. 14.
    Mulholland SG, Hanno P, Parsons CL, et al. Pentosan polysulfate sodium for therapy of interstitial cystitis. A double-blind placebo-controlled clinical study. Urology. 1990;35:552–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Parsons CL, Benson G, Childs SJ, et al. A quantitatively controlled method to study prospectively interstitial cystitis and demonstrate the efficacy of pentosanpolysulfate. J Urol. 1993;150:845–8.CrossRefPubMedGoogle Scholar
  16. 16.
    La Rock DR, Sant GR. Intravesical therapies for interstitial cystitis. In: Sant GR, editor. Interstitial cystitis. Philadelphia, PA: Lippincott-Raven; 1997.Google Scholar
  17. 17.
    Holm-Bentzen M, Jacobsen F, Nerstrøm B, et al. A prospective double-blind clinically controlled multicenter trial of sodium pentosanpolysulfate in the treatment of interstitial cystitis and related painful bladder disease. J Urol. 1987;138:503–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Nickel JC, Barkin J, Forrest J, et al. Randomized, double-blind, dose-ranging study of pentosan polysulfate sodium for interstitial cystitis. Urology. 2005;65:654–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Hanno PM, Burks DA, Clemens JQ, et al. AUA guideline for the diagnosis and treatment of interstitial cystitis/ bladder pain syndrome. J Urol. 2011;185:2162–70.CrossRefPubMedGoogle Scholar
  20. 20.
    Morales A, Emerson L, Nickel JC, et al. Intravesical hyaluronic acid in the treatment of refractory interstitial cystitis. J Urol. 1996;156:45–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Parsons CL, Lilly JD, Stein P. Epithelial dysfunction in nonbacterial cystitis (interstitial cystitis). J Urol. 1991;145:732–5.CrossRefPubMedGoogle Scholar
  22. 22.
    Rooney P, Srivastava A, Watson L, et al. Hyaluronic acid decreases IL-6 and IL-8 secretion and permeability in an inflammatory model of interstitial cystitis. Acta Biomater. 2015;19:66–75.CrossRefPubMedGoogle Scholar
  23. 23.
    Gupta SK, Pidcock L, Parr NJ. The potassium sensitivity test: a predictor of treatment response in interstitial cystitis. BJU Int. 2005;96:1063–6.CrossRefPubMedGoogle Scholar
  24. 24.
    Kallestrup EB, Jorgensen SS, Nordling J, et al. Treatment of interstitial cystitis with Cystistat: a hyaluronic acid product. Scand J Urol Nephrol. 2005;39:143–7.CrossRefPubMedGoogle Scholar
  25. 25.
    Riedl CR, Engelhardt PF, Daha KL, et al. Hyaluronan treatment of interstitial cystitis/painful bladder syndrome. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:717–21.CrossRefPubMedGoogle Scholar
  26. 26.
    Engelhardt PF, Morakis N, Daha LK, et al. Long-term results of intravesical hyaluronan therapy in bladder pain syndrome/interstitial cystitis. Int Urogynecol J. 2011;22:401–5.CrossRefPubMedGoogle Scholar
  27. 27.
    Hanno P, Baranowski A, Fall M, et al. Painful bladder syndrome (including interstitial cystitis). In: Abrams PH, Wein AJ, Cardozo L, et al., editors. Incontinence. 3rd ed. Paris: Health Publications Limited; 2005. p. 1456–520.Google Scholar
  28. 28.
    Daha LK, Riedl CR, Lazar D, et al. Do cystometric findings predict the results of intravesical hyaluronic acid in women with interstitial cystitis? Eur Urol. 2005;47:393–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Lv YS, Zhou HL, Mao HP, et al. Intravesical hyaluronic acid and alkalinized lidocaine for the treatment of severe painful bladder syndrome/interstitial cystitis. Int Urogynecol J. 2012;23:1715–20.CrossRefPubMedGoogle Scholar
  30. 30.
    Steinhoff G, Ittah B, Rowan S. The efficacy of chondroitin sulfate 0.2% in treating interstitial cystitis. Can J Urol. 2002;9:1454–8.PubMedGoogle Scholar
  31. 31.
    Nickel JC, Egerdie B, Downey J, et al. A real-life multicentre clinical practice study to evaluate the efficacy and safety of intravesical chondroitin sulphate for the treatment of interstitial cystitis. BJU Int. 2009;103:56–60.CrossRefPubMedGoogle Scholar
  32. 32.
    Nickel JC, Egerdie RB, Steinhoff G, et al. A multicenter, randomized, double-blind, parallel group pilot evaluation of the efficacy and safety of intravesical sodium chondroitin sulfate versus vehicle control in patients with interstitial cystitis/painful bladder syndrome. Urology. 2010;76:804–9.CrossRefPubMedGoogle Scholar
  33. 33.
    Nickel JC, Hanno P, Kumar K, et al. Second multicenter, randomized, double-blind, parallel-group evaluation of effectiveness and safety of intravesical sodium chondroitin sulfate compared with inactive vehicle control in subjects with interstitial cystitis/bladder pain syndrome. Urology. 2012;79:1220–4.CrossRefPubMedGoogle Scholar
  34. 34.
    Porru D, Leva F, Parmigiani A, et al. Impact of intravesical hyaluronic acid and chondroitin sulfate on bladder pain syndrome/interstitial cystitis. Int Urogynecol J. 2012;23:1193–9.CrossRefPubMedGoogle Scholar
  35. 35.
    Cervigni M, Natale F, Nasta L, et al. Intravesical hyaluronic acid and chondroitin sulphate for bladder pain syndrome/interstitial cystitis: long-term treatment results. Int Urogynecol J. 2012;23:1187–92.CrossRefPubMedGoogle Scholar
  36. 36.
    Gülpınar O, Kayış A, Süer E, et al. Clinical comparision of intravesical hyaluronic acid and hyaluronic acid-chondroitin sulphate therapy for patients with bladder pain syndrome/interstitital cystitis. Can Urol Assoc J. 2014;8:E610–4.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Cervigni M, Sommariva M, Tenaglia R, et al. A randomized, open-label, multicenter study of the efficacy and safety of intravesical hyaluronic acid and chondroitin sulfate versus dimethyl sulfoxide in women with bladder pain syndrome/interstitial cystitis. Neurourol Urodyn. 2017;36(4):1178–86.Google Scholar
  38. 38.
    Tyagi P, Kashyap M, Majima T, et al. Intravesical liposome therapy for interstitial cystitis. Int J Urol. 2017;24(4):262–71.Google Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Interstitial Cystitis Referral Center and Female Pelvic Medicine and Reconstructive Surgery Center, Foundation University Hospital A. Gemelli, Catholic UniversityRomeItaly

Personalised recommendations