Correlation of urinary glycosaminoglycan levels, and profile with disease severity in interstitial cystitis patients

445 WHAT

ARE

THE

SUPPORTIVE

STRUCTURES

OF

THE

FEMALE

URETHRA? Strasser -3

H.’ Kavaler E.‘, Lienemann

Female stress urinary incontinence is mainly thought to result from impairment of the supportive structures of the urethra. Surgical repair of female incontinence involves attachment of the urethra to the pubic bones or other surrounding structures, because fixation of the urethra is thought to be imperative to the maintenance of continence in adult females. For understanding of function and for creating a reliable surgical technique, exact knowledge of the anatomy of the connective tissue structures surrounding the female urethra is a prerequisite. & OBJECTIVES:

MATERIAL & METHODS: The topography around the female urethra was studied in undisturbed serial sections of 29 female fetuses and of 6 adult female pelves. The pelves of the female fetuses were processed according to plastination histology technique. The pelves of six adult specimens were processed according to sheet plastination technique and compared with MR images of II adult females.

RESULTS: The ventro-lateral aspect of the urethra remains free of fixating ligaments throughout its pelvic course. Ventro-laterally the urethra is enclosed by the ventral parts of the levator ani, its fasciae and a ventral urethral connective tissue bridge connecting both sides. Dorsally the urethra is intimately connected to the wall of the vagina. CONCLUSIONS: The female urethra has no direct ligamentous fixation to the pubic bone. Urethral continence comprised by childbirth can be explained by a widening of the hiatus of the levator ani, resulting in overstretching of the ventral urethral connective tissue bridge urethra and vagina. Therefore, surgical repair of these structures.

BLADDER

FUNCTION

or disruption of the fixation techniques should primarily

between include

‘University of Mersin School of Medicine, Dept. ‘University of Mersin School of Medicine, Department Mersin, Turkey

of Urology, of Histology

Mersin, Turkey, and Embryology,

INTRODUCTION & OBJECTIVES: Poor bladder capacity and compliance can bc improved by surgical augmentation and drug therapy. However, the high incidence of morbidity of medical and surgical treatment may limit long-term patient compliance. The purpose of this study was to investigate the effect of botulinum toxin A on bladder function and histology in a rat interstitial cystitis model. MATERIAL & METHODS: The study included 41 female Sprague-Dawley rats with interstitial cystitis induced by intravesical instillation of hydrochloric acid. The acid instillation was repeated monthly to maintain chronic inflammation. The treatment group (n=21) received 2-3 units of botulinum toxin A injection into the bladder detrusor at the 3, 6, 9 and 12 o’clock positions, and the control group (n=20) underwent saline injection into the bladder detrusor at the same positions. Urodynamic studies were performed in all rats before the treatment and at sacrifice. The rats were sacrificed at 1 week, 2 weeks, 1 month and 2 months, The bladders were removed and examined histologically for mast cells and inflammatory changes. RESULTS: The cystometric findings showed that, at the beginning and end of the experiment, the increases in the maximal bladder capacity and compliance after the treatment with botulinum toxin A or saline were significantly higher in the treatment group than in the control group (p=O.OOO and p=O.O25, respectively). At 2 weeks, the mean maximal bladder capacity increased by 88%*33.7 in the treatment group and decreased by 42.2%*4.4 in the control group, revealing highly statistically significantly difference (p=O.O03). The mean bladder compliance increased by 56.8%*48.1 in the treatment group and decreased by 55.1%*5.6 in the control group, revealing statistically significantly difference between the two groups (p=O.O14). The histologic studies revealed no significant differences in mast cell counts and leukocyte infiltration between the treatment and control groups. CONCLUSIONS: In this rat interstitial cystitis model, botulinum toxin type A injection into the bladder detrusor provided functional improvement. Thus, botulinum toxin A injection may be an alternative choice, as a minimally invasive, to other surgical treatment options in the treatment of chronic inflammatory condition to improve deteriorated bladder function.

447 CORRELATION OF URINARY GLYCOSAMINOGLYCAN LEVELS, AND PROFILE WITH DISEASE SEVERITY IN INTERSTITIAL CYSTITIS PATIENTS Lorenzo-Gamer M-F., Schroeder G.L, Kcster R.R., Go& University of Miamr School of Medicine, States of America

Urology

A.E., Lokeshwar V.B

(M-800).

Miami,

Florida,

United

INTRODUCTION & OBJECTIVES: Urothelial glycosaminoglychn (GAG) layer offers a protective coating to the bladder urothehum. An imbalance in this layer may either cause interstitial cystitis (IC) or a result of it. In this study we correlated urinary GAG levels and GAG profile with disease severity and pathologic parameters. We also tested whether GAG levels can be used to follow IC patients and predict treatment response. MATERIAL & METHODS: Over a 12.month period 4 I Voided urine specimens were prospectively collected from 23 IC patients and 6 age matched normals. Among these 8 IC patients and 2 normals gave at least 2 urine specimens. Total urinary GAG concentrations were measured by Bitter and Muir assay. The total GAG levels were normalized to creatinine. Urinary GAG profiles were determined by G-50 gel-filtration chromatography. Results were correlated with a validated problem and symptom indices questionnaire (O’Leary and Sam) and pathologic parameters (IC patients: glomemlation, bloody ehlux, cystometric and anesth&ed bladder capacity and urine analysis). RESULTS: Total urinary GAG levels (2219 f 359 mgimg Cr) were 4 to 6-fold elevated in IC patients who had both problem (i.e., 18116) and symptom (i.e., >10/20) indices >50%, when compared to the levels in IC patients with one of the two indices ~50% (497190.3mgimg Cr) and normal controls or IC patients with both indices ~50% (369il27 mg/mg Cr) (P50% and GAG levels >lOOO mgimg Cr (PlOOO mg GAG/mg Cr, did not respond to any treatment. The analysis of GAG profiles showed that IC patients with >50% problem and symptom indices have 3 distinct urinary GAG peaks whereas, the GAG profiles of normals and IC patients with one or both problem and symptom indices ~50% have either one (peak Ill) or two (peaks I and III) peaks. Fisher’s exact test showed a significant correlation between problem and symptom indices being >50% and the presence of 3 urinary GAG peaks (P=O.O076; two-sided; OR=45). No significant correlation was observed between pathologic parameters and GAG levels/GAG profile (Fisher’s exact test: P=O.6). During follow-up the GAG levels correlated with patients’ problem and symptom indices (P
446 SEMI QUANTITATIVE ANALYSIS DIFFERENT “SLING” MATERIALS: fhiel M.‘, Palma P. , Riccrtto Barreta A.‘. Teixeira A.’

Urology

Supplements

2 (2003) No. 1, pp. 114

OF HISTOCOMPATIBILITY OF AN EXPERIMENTAL STUDY

c‘.‘, Dambros M.‘, Heronann

V.‘. Netto jr N.

Ilnivcrsidadc Estadual de Campmas, Urology. Campina\. Fstadual de Campinas, Gynecology, Campinas, Brazil

Hra/il.

Fraga K

‘tlnivcrsidadc

INTRODUCTION & OBJECTIVES: Mmnnally invasive slings are presently one of the most used procedures in the management of female urinary incontinence (USI). There are many different commercially available slings, absorbable and nonabsorbable as well. This experimental study compares local tissue reaction elicited by the four most frequent used materials.

MATERIAL & METHODS: There were sixty female Wistar rats, eight weeks of age. Under general anaesthesia. an abdominal incision was performed and a 8x4 mm implant of non-absorbable polypropylene mesh from Tension-free vaginal tape (TVT), and silicone anchoring - tail from SAFYRE, along with absorbable swine small intestine submucosa (SIS) and polygalactin co-polymers (Sabre). Semi quantitative analysis of the local tissue reaction was studied at 7, 30 and 90 days, comparing inflammation necrosis, granuiomatous reaction and fibrosis, using hematoxilin-eosin staining. round cells inflammation was present in difference between them. There was no neutrophilic reaction or necrosis. One month after the surgery, granulomatous reaction was present in 60% of the polypropylene mesh and polygalactin co_-polymers and in 90% of the silicone and SIS implants, Regarding the intensity of the inflammatory reaction, polypropylene mesh and polygalactin presented similar mild inflammatory reaction. Silicone elicited mild reaction and SIS the more intense reaction. No necrosis or infection was noted. Granulation tissue formation was greater with RESULTS:

One week after the implantation

all four groups

with no significant

polygalactin, second by the polypropylene mesh; silicone and SIS present similar results. Fibrosis induced bv the nolvoronvlene mesh was similar to the nolvealactin

and greater than silicone and SIS: Att‘hrek;nonths, inflammatory reaction’wasnoticed in only 10% of the polypropylene mesh and polygalactin implants, and in 100% of the silicone and SIS implants. Despite the difference and the frequency there was no difference in the intensity of the tissue reaction, There was no difference in the fibrosis induced by the different materials at this time. Although polypropylene mesh and polygalactin induce early fibrosis and less inflammatory reaction at three months, the semi quantitative analysis showed no difference in fibrosis formation in all erouns. This tindines sunnort the use of both absorbable and non-absorbable matezals’ for minimally i&&e sling orocedure. CONCLUSIONS:

CONCLUSIONS: Total urinary GAG levels and GAG profile could be used as objective measures to assess the severity of IC during diagnosis and follow-up, as well as to predict the treatment response. Support: Fishbein Family Interstitial Cystitis Research Foundation; NlHiNCl CA 7282 1.

European

IN A

Cavan S.‘, Coskun B.‘, Bozlu M.‘, Acar D.‘, Ulusoy E.‘, Akbay E.’

A.‘, Bartsch G.‘, Fritsch H.’

‘University of Innsbruck, Department of Urology, Innsbruck, Austria, ‘LMU University Munich, Department of Radiology, Munich, Germany, ‘University of Innsbruck, Institute of Anatomy and Histology, Innsbruck, Austria INTRODUCTION

446 BOTULINUM TOXIN A MAY IMPROVE RAT INTERSTITIAL CYSTITIS MODEL