useful signs anf criteria in diagnostics of ic/bps
DESCRIPTION
method of standardization and optimization of the parameters at bladder distension Attempts to improve therapeutic efficacy in IC/BPS. Useful signs anf criteria in diagnostics of IC/BPS. Pelvic pain and dyscomfort Frequent urination Urge symptoms Negative urine test Exclusion of UTI - PowerPoint PPT PresentationTRANSCRIPT
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Pelvic pain and dyscomfort
Frequent urination
Urge symptoms
Negative urine test
Exclusion of UTI
Presence of symptoms >3 months
Characteristic view at cystoscopy (in
70%)
Exclusion of all other bladder illnesses
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Pelvic pain and dyscomfort
Frequent urination
Urge symptoms
Negative urine test
Exclusion of UTI
Presence of symptoms >3 months
Characteristic view at cystoscopy (in
70%)
Exclusion of all other bladder illnesses
![Page 4: Useful signs anf criteria in diagnostics of IC/BPS](https://reader036.vdocument.in/reader036/viewer/2022062315/56815a9a550346895dc81609/html5/thumbnails/4.jpg)
Extension of visible mucosa glomerulations depends on:• level of intravesical pressure • time of dilation.
Standardization and optimization of these parameters is urgently needed.
Extension of visible mucosa glomerulations depends on:• level of intravesical pressure • time of dilation.
Standardization and optimization of these parameters is urgently needed.
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Issues at conventional hydrodilation
Unreliable volume control
• Vesico-ureteral (renal) reflux
• Leakage through the urethra
Uncertainties at pressure adjustment
• Inaccurately defined zero level
• Reference pressure must correspond with perivesical pressure
• Adjustment of hydrostatic pressure is unexact
NEW METHOD NEEDEDNEW METHOD NEEDED
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• Hyaluronate + 2% Lidocain solution into the
bladder• Balloon filled up to 70cmH2O• Keep pressure for 5 minutes• Quick collapse: ex vacuo bleedings
• Hyaluronate + 2% Lidocain solution into the
bladder• Balloon filled up to 70cmH2O• Keep pressure for 5 minutes• Quick collapse: ex vacuo bleedings
Standardized circumstances
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After balloon dilation
Unequivocal lesions visible
Extended, deep coagulation (vaporization) of all mucosal glomerulations and ulcers
Bladder catheter for 16-24 hours
Adjuvant Hyaluronate + Lidocain instillations
Repeated instillations weekly 2x for 2 weeks, weekly 1x for 4 weeks (8 times)
Continuous follow up by questionaires and miction diary
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Evaluation of pressure-volume relation:Always a bi-parabolic correlation!
Bladder wall rupture !Bladder wall rupture !
Suddenly decreasing pressure
Suddenly decreasing pressure
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Evaluation of pressure-volume relation:cysto-elastometric PC software
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Use balloon dilation of the bladder instead of conventional hydrodilation
Proved advantages:
- no leakage - no v-u reflux - exact and reliable pressure controll - better visualisation of all mucosal lesion - simultaneous high pressure drug delivery
Standardized parameters (pressure, time)
Summary of our experiences
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Extended and deep coagulation of all mucosal lesions
Adjuvant GAG replenishment therapy helps (best timing, dose and durance ?)
Repeated procedure - if necessary - brings similar result
Evaluation of volume-pressure dependence let define new objective parameters: bladder volume, distensibility, grade of dilation
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Presented method is of
Diagnostic valueBetter visualisation of all mucosal lesions
Therapeutic valueExtended coagulation of otherwise unvisible
lesions
Prognostic valueEvaluation of pressure-volume relation let rate
phase of the illness