IC Flashcards
Make sure you send your urine for both UA AND culture
Dont forget to say it explicitly.
What percentage of IC patients will have a hunner’s lesion?
5-10%
Does the presence of hunner’s lesions increase the risk of bladder cancer?
No
Your LUTS patient has atypical urine cytology.
What’s your DDx?
-chronic UTIs
-stones
-malignancy
-IC
-recent instrumentation
-intravesical medications
Describe staging of bladder cancer.
Ta- exophytic/papillary
Tis- carcinoma in situ- flat
T1- submucosa
T2- detrusor invasion
T3- perivesical fat
T4- adjacent organs
How deep of a bladder biopsy do you do?
Take mucosa and muscularis.
What is your treatment algorithm for IC?
Stepwise approach:
- diet, stress relief, PFPT, analgesics
- Medications: Oral or intravesical
- Procedure- onabotulinumA injections, cystoscopy with hydrodistention, SNM
- end stage- refer to urology to consider cystectomy or diversion
Amitriptyline
Dose:
MOA:
Efficacy:
Side Effects
Dose: 10 mg at bedtime, up to 75mg at bedtime
MOA: SNRI
Efficacy: 64-90%
Side Effects: sedation, anti-cholinergic effects, weight gain, ortho hypotension, cardiac abnormalities
Cimetidine
Dose:
MOA:
Efficacy:
Side Effects:
Dose: 200-400mg BID
MOA: H2 blocker
Efficacy: ~50% (all oral meds besides amitriptyline- 64-90% and pentosan polysulfate-10%)
Side Effects: minimal
Pentosan polysufate sodium
Dose:
MOA:
Efficacy:
Side Effects:
Dose: 100-300mg PO TID for 3-6 months
MOA: low molecular weight heparinoid which replaces the GAG layer deficiency in the epithelium
Efficacy: ~10%,
SE: Macular (stars at 3 years) , alopecia, increased bleeding, liver dysfunction
Only FDA approved
Phenazopyridine
Side Effects
Liver and renal toxicty
NOT meant for use for more than 2 days use
Effects of lidocaine toxicity
perioral numbness
dizziness
seizure,
tingling
ringing ears
hypotension
Describe your basic evaluation for IC?
H+P
PVR
UA, UCx
Bladder diary
Describe the steps of cysto hydro.
- Anesthesia
- raise the IV to 60-80 cm above the pubic symphysis
- instill sterile water gradually using bladder capacity is reached.
- observe for 5 min max
- empty the bladder and measure the volume.
- cysto again, fulguration or inject hunner’s lesion
during your cysto hydro, the bladder ruptures.
What next?
Assess:
-size, > or < 2 cm
-location,
-intraperitoneal vs extraperitoneal
-was electrocautery involved
How much triamcinolone do you inject in a Hunner’s lesion?
10cc in 0.5 aliquots
100mg
Your IC patient fails both fulguration and triamcinolone injection of Hunner’s lesion.
What else can you try?
Oral cyclosporine A
Cyclosporine A
Dose:
MOA:
Efficacy:
Side Effects
Dose: 3 mg/ kg/day divided into two doses for 3 months
MOA: immunosuppressive agent that inhibits the transcription of the cytokine IL2
Efficacy: 80-90% significant improvement in pain
SE: HTN, increased serum creatinine, gingival hyperplasia, facial hair growth
What is the efficacy of PFPT for IC?
59% showed improvement
Hydroxyzine
Dose:
MOA:
Efficacy:
Side Effects:
Dose: Anti-histamine
MOA: 10-50mg daily
Efficacy: ~50%
Side Effects: sedation, weakness
MOA of methenamine
hydrolyzes to formaldehyde and ammonia in acidic urine, which is baceriocidal
Dimethyl Sulfoxide
Dose:
MOA:
Efficacy:
Side Effects:
Dose: 50cc of 50% DMSO, hold for 15-20 minutes
MOA: replace the GAG layer
Efficacy: 93%
Side Effects: garlic taste or smell from the patient. lasting several hours; PAIN
What are the effects of sodium bicarb in a BI?
reduces acidity and increased penetration of lidocaine
Discuss the theories of IC etiologies.
- Epithelial alterations in the urothelium
- Neurogenic inflammation caused by mast cell activation.
- Infectious causes
- Centralized pain processing
- Altered brain structure and function
