METHOD OF STANDARDIZATION AND OPTIMIZATION OF THE PARAMETERS

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 Presence of symptoms >3 months Characteristic view at cystoscopy (in 70%) Exclusion of all other bladder illnesses

Current method of hydrodistension 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

Most important diagnostic tool: High Pressure Cystoscopy Extension of visible mucosa glomerulations depends on: • level of intravesical pressure • time of dilation. Standardization and optimization of these parameters is urgently needed.

Most important diagnostic tool: High Pressure Cystoscopy 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 NEEDED

Improved method: high pressure balloon dilation of the bladder • Hyaluronate + 2% Lidocain solution into the bladder • Balloon filled up to 70 cm. H 2 O • Keep pressure for 5 minutes • Quick collapse: ex vacuo bleedings Standardized circumstances

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 2 x for 2 weeks, weekly 1 x for 4 weeks (8 times) Continuous follow up by questionaires and miction diary

Evaluation of pressure-volume relation: Always a bi-parabolic correlation! Suddenly decreasing pressure Bladder wall rupture !

Evaluation of pressure-volume relation: cysto-elastometric PC software

Samples of long lasting good results

TAKE HOME MESSAGE Summary of our experiences 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)

TAKE HOME MESSAGE 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

TAKE HOME MESSAGE Presented method is of Diagnostic value Better visualisation of all mucosal lesions Therapeutic value Extended coagulation of otherwise unvisible lesions Prognostic value Evaluation of pressure-volume relation let rate phase of the illness