Introduction: The aim of this study was to examine the efficacy and safety of intravesical Bacillus Calmette-Guerin (BCG) in the treatment of refractory INTERSTITIAL CYSTITIS (IC).Materials and Methods:  Thirteen patients with refractory IC were enrolled in the study. They were scheduled to receive 6 weekly courses of treatment with intravesical BCG. Variables including the frequency, nocturia, urgency, pelvic pain, dyspareunia, dysuria, IC symptom index, IC problem index, and average voided volume were assessed every 6 months after the BCG therapy. Results: Thirteen patients received the complete course of intravesical BCG therapy. Twenty-four months after the treatment a mean improvement of 51.9% was seen in frequency (P = 0.001), 43.2% in nocturia (P = 0.002), 28.7% in urgency (P = 0.004), 43.1% in pelvic pain (P = 0.001), 58.3% in dyspareunia (P = 0.003), 6.5% in dysuria (P = 0.16), 57.7% in the O’Leary-Sant IC symptom index (P = 0.001), and 61.8% in the O’Leary-Sant IC problem index (P = 0.001) scores. A significant improvement was seen in the mean average voided volume at the 24th follow-up month (89.5%; P = 0.001).Conclusion: Intravesical BCG is a relatively effective treatment in patients with refractory IC. Its efficacy seems to be modest and lasts for at least 24 months in majority of the patients. It is also safe and well tolerated.

Introduction: To assess the effects of treatment with oral Cornu’, s mas and sucralfate, and intravesical hyaluronic acid (HA) on bladder histopathology and inflammatory cells in vivo model of Bladder pain syndrome/INTERSTITIAL CYSTITIS (BPS/IC). Methods: A total of 25 female rats were grouped: control (group I), IC (group II), HA (group III), Sucralfate (group IV), and Cornu’, s mas (group V). Chemical CYSTITIS was induced in four groups (all except the control group) by the intravesical instillation of Hydrogen peroxide, Cornu’, s mas extract for 7 days twice a day, sucralfate for seven days twice a day, and HA every week for a month and then every month for two months were administered. Bladder tissue was removed to check inflammatory cell infiltration by histopathological examination. Results: A total of 25 female rats were grouped: control (group I), IC (group II), HA (group III), Sucralfate (group IV), and Cornu’, s mas (group V). Chemical CYSTITIS was induced in four groups (all except the control group) by the intravesical instillation of Hydrogen peroxide, Cornu’, s mas extract for 7 days twice a day, sucralfate for seven days twice a day, and HA every week for a month and then every month for two months were administered. Bladder tissue was removed to check inflammatory cell infiltration by histopathological examination. Conclusions: Intravesical injection of HA and oral administration of sucralfate, and Cornu’, s mas were able to reduce the inflammation severity but not the normal level in the rat model of BPS/IC.

Context: INTERSTITIAL CYSTITIS is a multifactorial chronic and debilitating disease which is commonly associated with pain localized in the bladder region, increased urinary frequency, urgency and nocturia. Due to the high prevalence of pain in the population affected more recently the condition is often referred to as INTERSTITIAL CYSTITIS / bladder pain syndrome (IC/BPS).Evidence Acquisition: Although IC presents with many different symptoms, researchers have formulated three different theories, which are not mutually exclusive, to explain IC pathology: the first is related to the alteration of the proteoglycan and protein junction composition, structure and presence in the urothelium. The second is an immune induced IC resulting from an increased number of activated mast cells in the bladder internal layers, such as detrusor muscle (DM), and mucosa/submucosa. The third type, which is closely related to the second one, is due to a sensory nerve sensitization as an effect of neurotrophic factors molecule release.Results: Previous classification has been mirrored in the development of various in vitro and in vivo disease models created to mimic IC, as well as in the available therapies used to treat the condition to date. Conclusions: This review will summarize the most recent advances in the field, related to the different causative factors contributing to the development of the condition, thein vivo models used as well as the evidence they provide in advancing our knowledge and their limitations. The focus will be on works reporting on IC in the domain related to alterations in proteoglycans and cellular junction, specifically their composition, structure and appearance in the urothelium, and also discuss present and future therapies.Conclusions: This review will summarize the most recent advances in the field, related to the different causative factors contributing to the development of the condition, the in vivo models used as well as the evidence they provide in advancing our knowledge and their limitations. The focus will be on works reporting on IC in the domain related to alterations in proteoglycans and cellular junction, specifically their composition, structure and appearance in the urothelium, and also discuss present and future therapies.

Purpose: To evaluate the clinical efficacy of bladder hydrodistention and intravesical sodium hyaluronate in the treatment of INTERSTITIAL CYSTITIS (IC). Materials and Methods: Twenty-one patients with IC received intravesical sodium hyaluronate therapy under nerve block or intravenous anesthesia. Bladders were perfused with 100 cmH2O perfusion pressure and expanded for 10 min and were later injected with 40 mg/50 mL sodium hyaluronate through the catheter. After 1 h, the perfusion fluid was released. Perfusion was applied once per week, 4 to 6 times as a course of treatment. Results: Under anesthesia, the average bladder capacity was 191. 62 ± 88. 67 mL, and after bladder expansion, the bladder capacity reached 425. 33 ± 79. 83 mL (P =. 000). There were 2 suspected bladder ruptures after bladder expansion at 6. 5 min and 7. 2 min. After 10 min of bladder expansion, there were 19 cases of significantly gross hematuria. After treatment, the catheters of 17 patients were removed at 24 h; for the 2 cases of hematuria, catheters were removed at 72 h and for the 2 cases of suspected bladder rupture, catheters were removed after 4 days. After catheter removal, the pain threshold significantly decreased, and the maximum urinary output increased slightly. Compared with values before treatment, the day before the second injection of sodium hyaluronate, the frequency of urination decreased significantly (32. 8 vs. 18. 5 times/24 h), the maximum urinary output increased significantly (86. 7 vs. 151. 9 mL), the pain decreased significantly (8. 7 vs. 3. 0), and the O'Leary-Sant IC score and quality of life score were significantly decreased (30. 0 vs. 17. 0 and 5. 9 vs. 2. 4, respectively) (P =. 000). Conclusion: Bladder hydrodistention under anesthesia for patients with severe intractable IC produces immediate effectiveness; sodium hyaluronic infusion can alleviate frequent urination and pain, and the efficacy was positively correlated with the duration of treatment.

Dear Editor-in-Chief INTERSTITIAL CYSTITIS (IC) or bladder pain syndrome (BPS) is considered a devastating condition of chronic nature (1) which can have negative im-pact on the patients’ quality of life (2). American Urological Association describes the term IC/BPS as “ An unpleasant sensation (pain, pres-sure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of longer than 6 weeks’ duration, in the absence of infection or other identifiable causes” (3).

Objective(s): We investigated the relationship between the expression of tumor necrosis factor-inducible gene 6 (TSG-6) with inflammation and integrity of the bladder epithelium in the bladder tissues of patients with bladder pain syndrome/INTERSTITIAL CYSTITIS (BPS/IC) and the mechanism of action using a rat model of BPS/IC. Materials and Methods: Expression of TSG-6 and uroplakin III was determined by immuno-histochemistry of bladder biopsy samples from control human subjects and patients with verified BPS/IC. Our rat model of BPS/IC was employed to measure the perfusion of bladders with hyaluronidase, and assessment of the effect of TSG-6 administration on disease progression. Treatment effects were assessed by measurement of metabolic characteristics, RT-PCR of TGR-6 and interleukin-6, bladder histomorphology, and immunohistochemistry of TGR-6 and uroplakin III. Results: The bladders of patients with BPS/IC had lower expression of uroplakin III and higher expression of TSG-6 than controls. Rats treated with hyaluronidase for 1 week developed the typical signs and symptoms of BPS/IC, and rats treated with hyaluronidase for 4 weeks had more serious disease. Administration of TSG-6 reversed the effects of hyaluronidase and protected against disease progression. Conclusion: Our results indicate that TSG-6 plays an important role in maintaining the integrity of the bladder epithelial barrier.