James Chivian Lukban

Current management of interstitial cystitis

The management of patients with IC remains a challenge because no single agent has proven universally effective. DMSO and PPS have been evaluated through early placebo-controlled trials, and these two agents are FDA approved treatments for IC. BCG is currently undergoing a large placebo-controlled trial, and hyaluronic acid is receiving similar clinical evaluation. Sacral nerve root stimulation shows promise with early favorable results. As with any treatment algorithm, it is reasonable to begin with conservative treatment using time-dependent milestones, allowing adequate trials of successive therapy while ensuring an appropriate pace for timely symptom resolution.

Pelvic floor muscle re-education treatment of the overactive bladder and painful bladder syndrome

Normal function of the pelvic floor musculature is essential in maintaining appropriate function of the pelvic viscera. Low-tone pelvic floor dysfunction, as may be seen in patients with pelvic floor musculature denervation, can contribute to pelvic organ prolapse, transurethral urinary incontinence, vaginal laxity, or transrectal fecal incontinence. High-tone pelvic floor dysfunction, as may occur in patients with overactive bladder or painful bladder syndrome (interstitial cystitis), can manifest as voiding dysfunction, sexual dysfunction with dyspareunia, or fecal retention. Pelvic floor rehabilitation for patients with pelvic floor dysfunction is performed in an effort to restore normal tone and function to the muscles of the pelvic floor, and in patients with overactive bladder may provide an additional element of reflex bladder inhibition. Muscle reeducation techniques, typically preceded by a trial of behavioral therapy, include pelvic floor musculature exercises, pelvic floor musculature exercises with biofeedback, and electrical stimulation. The purpose of this chapter is to discuss the use of pelvic floor musculature rehabilitation to treat overactive bladder and to correct high-tone pelvic floor dysfunction.

Evaluation of transvaginal theile massage as a therapeutic intervention for women with interstitial cystitis.

pared using the sign-rank test. A total of 203 patients completed the survey, for a response rate of 53.6%. Analysis of attrition demonstrated no difference between the participants and nonparticipants regarding age, severity of symptoms and associated conditions. A decrease in symptom severity was seen in .40% of responders with exacerbation to pizza, coffee, acidic fruits and juices, spicy foods, and tomato-based products. A 20%–30% reduction was seen in responders with exacerbation related to carbonated drinks, alcohol, and chocolate. Pain and discomfort decreased from 5.3 to 3.6 (P,0.0001), whereas urgency was reduced from 5.3 to 4.1 (P,0.001). Regarding quality of life issues, the majority of responders had a positive change or no change (P ,0.0001). CGP appears to reduce IC symptoms in patients with food-related exacerbations and improve their quality of life.

Anterior enterocele: a report of three cases

Anterior enterocele is an uncommon finding in patients with pelvic organ prolapse. We reviewed 490 consecutive operations for pelvic organ prolapse . Three anterior enteroceles were identified in a series of 193 enterocele repairs (1.6%). The presentation and treatment of each of these patients is reviewed.

Safety and effectiveness of Colpexin Sphere in the treatment of pelvic organ prolapse

Our objective was to determine the safety and effectiveness of Colpexin Sphere in women with advanced genital prolapse. A total of 39 subjects were enrolled in our prospective multicenter clinical trial, and 27 completed the full 16-week assessment. At baseline, subjects were fitted with a sphere, instructed on insertion and removal, and educated on a regimen of pelvic floor muscle exercises performed with the device in place. Efficacy was evaluated by a baseline vs 16-week comparison of pelvic organ prolapse staging and pelvic floor muscle strength assessment. Safety evaluation included, but was not limited to, an assessment of vaginal mucosal integrity. Subjects also completed a patient satisfaction questionnaire at the end of the study. Improvement in the prolapse of at least one vaginal segment was seen in 81.5% of the subjects, while 63% exhibited improved muscle function on digital examination at 16 weeks. Twenty-five (92.6%) would recommend the device to treat prolapse, and most found it easy to insert (96.3%) and remove (100%). In short-term usage, problems with urination (29.6%) and defecation (72%) were reported, primarily due to device displacement. Two subjects developed superficial vaginal mucosal ulceration, which resolved spontaneously. No significant adverse events were reported.