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European UrologyVolume 47, issue 3, pages 273-426, March 2005
Do Cystometric Findings Predict the Results of Intravesical Hyaluronic Acid in Women with Interstitial Cystitis?
Accepted 26 October 2004, Published online 18 December 2004, pages 393 - 397
Introduction and objectives:
According to National Institute of Health (NIH) criteria, a bladder capacity of less than 350 cc is an automatic exclusion for a diagnosis of Interstitial Cystitis (IC). In the present study, patients, showing symptoms of IC and with bladder capacities of <350 and ≥350 cc were tested as to their response to a intravesical hyaluronic acid therapy.
The study included 48 patients with clinical symptoms of IC and a positive 0.4 M potassium sensitivity test. Maximum bladder capacity (Cmax) was assessed for the 0.9% NaCl solution first and then for the 0.2 M KCl solution. After the NaCl cystometry, patients were separated into two groups: Group I with a Cmax of <350 cc and Group II with a Cmax of ≥350 cc. Both groups were again separated in two further groups as to the respective percentage reduction of Cmax with the 0.2 M KCl solution: Group Ia/IIa (≥30%) and Group Ib/IIb (<30%). Patients were treated with weekly instillations of 40 mg hyaluronic acid for 10 consecutive weeks. Pre- and post-treatment bladder symptoms were evaluated through their visual analog scale (VAS) scores.
With the saline solution, 32 patients had a Cmax of <350 cc (Group I), while 16 patients had a Cmax of ≥ 350 cc (Group II). Evaluation of VAS scores confirmed a positive response, i.e. symptom relief, to hyaluronic acid therapy, irrespective of bladder capacity. The improvement was particularly evident in patients with a Cmax reduction of ≥30% versus those with a reduction of <30% with the 0.2 M KCl solution (p = 0.003).
The present study demonstrates that patients with typical IC symptoms and a cystometric bladder capacity of ≥350 cc, may have increased potassium sensitivity as a sign of IC and show symptom improvement after hyaluronic acid instillation therapy.
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