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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
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
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.
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
• 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
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
Evaluation of pressure-volume relation:Always a bi-parabolic correlation!
Bladder wall rupture !Bladder wall rupture !
Suddenly decreasing pressure
Suddenly decreasing pressure
Evaluation of pressure-volume relation:cysto-elastometric PC software
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
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
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