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Useful signs anf criteria in diagnostics of IC/BPS

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

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Useful signs anf criteria in diagnostics of IC/BPS

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  1. method of standardization and optimization of the parameters at bladder distension Attempts to improve therapeutic efficacyin IC/BPS

  2. 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

  3. Currentmethod 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

  4. Most important diagnostictool:HighPressureCystoscopy • Extension of visiblemucosaglomerulationsdependson: • level of intravesical pressure • time of dilation. • Standardization and optimization of theseparameters is urgentlyneeded.

  5. Most important diagnostictool:HighPressureCystoscopy 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

  6. Improvedmethod:highpressureballoondilation of thebladder • Hyaluronate+ 2% Lidocainsolutionintothebladder • Balloonfilled upto 70cmH2O • Keeppressurefor 5 minutes • Quick collapse: ex vacuobleedings Standardized circumstances

  7. 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

  8. Evaluation of pressure-volume relation: Always a bi-parabolic correlation! Suddenly decreasingpressure Bladderwallrupture !

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

  10. Samples of longlastinggoodresults

  11. 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) Takehomemessage Summary of our experiences

  12. Takehomemessage 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-pressuredependenceletdefinenewobjectiveparameters: bladdervolume, distensibility, grade of dilation

  13. Takehomemessage Presentedmethod is of DiagnosticvalueBettervisualisation of allmucosallesions TherapeuticvalueExtendedcoagulation of otherwiseunvisiblelesions PrognosticvalueEvaluation of pressure-volumerelationletratephaseoftheillness

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