Glup montecchio painful bladder syndrome_soligo
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U.O. Ginecologia e Ostetricia U.O. Ginecologia e Ostetricia Ospedale San Carlo Borromeo – Milano Ospedale San Carlo Borromeo – Milano Direttore Mauro Buscaglia Direttore Mauro Buscaglia M. Soligo Painful Bladder Syndrome ♀ "URODINAMICA PRATICA NELLE DISFUNZIONI PELVI PERINEALI FEMMINILI: DALL'ESECUZIONE ALL'INTERPRETAZIONE“ MONTECCHIO EMILIA (RE), 24 SETTEMBRE 2010
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Glup Montecchio 24-9-10
Transcript of Glup montecchio painful bladder syndrome_soligo
U.O. Ginecologia e Ostetricia U.O. Ginecologia e Ostetricia
Ospedale San Carlo Borromeo – MilanoOspedale San Carlo Borromeo – Milano
Direttore Mauro BuscagliaDirettore Mauro Buscaglia
M. Soligo
Painful Bladder Syndrome
♀
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MO
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CH
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MIL
IA (
RE
),
24 S
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MB
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20
10
"UR
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MIC
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MO
NT
EC
CH
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MIL
IA (
RE
),
24 S
ET
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MB
RE
20
10
Painful Bladder Syndrome
"UR
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MIC
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MO
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CH
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RE
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Painful Bladder Syndrome
La prospettiva storica
Interstitial Cystitis (IC) “inflammation that has destroyed the mucous
membrane partly or wholly and extended to muscular parietes”
1887 Alex Skene
1915 HunnerHunner ulcer
8 cases of red, bleeding patches on cystoscopy
223 cases of petechial, submucosal hemorrhages on cystoscopy after hydrodistention
defined as Glomerulations by Walsh1949 Hand& later Walsh
1978 Messing & StameyInterpretation
Glomerulations hallmark of early ICHunner ulcer late disease
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Painful Bladder Syndrome
La prospettiva storica
Interstitial Cystitis (IC) • Bladder pain
• Urgency• Glomerulations or Hunner’s ulcer
+ Exclusion of 18 elements
1987 NIDDK* Definition
*National Institute of Diabetes and Digestive and Kidney Diseases
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MO
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CH
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MIL
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RE
),
24 S
ET
TE
MB
RE
20
10
Painful Bladder Syndrome
La prospettiva storica
Interstitial Cystitis (IC) • Bladder pain
• Urgency• Glomerulations or Hunner’s ulcer
+ Exclusion of 18 elements
1987 NIDDK* Definition
*National Institute of Diabetes and Digestive and Kidney Diseases
2002 ICS terminology Standardization Painful Bladder Syndrome
"UR
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CU
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PR
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AZ
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MO
NT
EC
CH
IO E
MIL
IA (
RE
),
24 S
ET
TE
MB
RE
20
10
Painful Bladder Syndrome
"UR
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INA
MIC
A P
RA
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A N
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DIS
FU
NZ
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I P
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VI
PE
RIN
EA
LI
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MM
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I: D
AL
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CU
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NE
A
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'INT
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PR
ET
AZ
ION
E“
MO
NT
EC
CH
IO E
MIL
IA (
RE
),
24 S
ET
TE
MB
RE
20
10
Painful Bladder Syndrome
"UR
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INA
MIC
A P
RA
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A N
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DIS
FU
NZ
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I P
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RIN
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AZ
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MO
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CH
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MIL
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RE
),
24 S
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Painful Bladder Syndrome
• Urethral• Vulval• Vaginal• Scrotal• Perineal• Pelvic
Pain syndromes
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CH
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20
10
Painful Bladder Syndrome
"UR
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A N
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FU
NZ
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RIN
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I: D
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MO
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CH
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MIL
IA (
RE
),
24 S
ET
TE
MB
RE
20
10
Painful Bladder Syndrome
♀
"UR
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A N
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DIS
FU
NZ
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I: D
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CU
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PR
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AZ
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MO
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EC
CH
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MIL
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RE
),
24 S
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MB
RE
20
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Painful Bladder Syndrome
♀
"UR
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MO
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MB
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Painful Bladder Syndrome
♀
♀/♂ ratio 10:1
Mean Age 40s
Prevalence across the world
1-4/105 Japan
18/105 Finland
52-67/105 U.S.A.
Epidemiology
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Painful Bladder Syndrome
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Lower QoL than dyalisis patients; 6 times more likely to miss work
Non pharmacologic
Management
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Painful Bladder Syndrome
♀• Diet
• Behavioral adaptation
• Bladder retraining
• PF rehabilitation
• Comorbitity treatments
Pharmacologic oral• Pentosan Polysulfate Sodium (PPS)
• Amitriptyline
Pharmacologic topic 6 Randomized trials: inconclusive
evidence
Cochrane Review, 2007
Hydrodistention
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RE
),
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20
10
Painful Bladder Syndrome
34 refractory IC 30 implanted (> 50% symptoms improvement)
*Pelvic pain Urgency/Frequency (PUF) score
All P<0.01
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Painful Bladder Syndrome
♀GrazieGrazie
Les chichoteusesLes chichoteuses
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CH
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RE
),
24 S
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Painful Bladder Syndrome
♀
A clincal diagnosis of exclusion
• No specific tests available
• Cystoscopy no longer indicated for diagnosis
• Urodynamic unnecessary
Micturition chart of pivotal importance
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MB
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Painful Bladder Syndrome
♀
