Sushma Srikrishna

Interstitial cystitis: diagnosis and management

Interstitial cystitis/painful bladder syndrome is a chronic condition that causes debilitating bladder pain which can be associated with urgency, frequency and nocturia. Its cause is not clear and it is still a disease diagnosed by exclusion. Oral or intravesical therapies are the main stay of treatment whilst surgical procedures are reserved for refractory cases. This condition usually warrants a multidisciplinary approach for optimum outcome. This article gives an overview of the changes in definition, aetiopathogenesis and available treatments.

Management of overactive bladder syndrome

Overactive bladder (OAB) syndrome is the term used to describe the symptom complex of urinary urgency with or without urge incontinence, usually with frequency and nocturia. Drug treatment continues to have an important role in the management of women with OAB. Other treatment options include conservative management with lifestyle interventions, modification of fluid intake, and physiotherapy including bladder retraining. Surgery remains the last resort in the treatment and is usually reserved for intractable detrusor overactivity, as it is associated with significant morbidity. This article reviews the management of the overactive bladder with specific focus on newer developments in the medical treatment of OAB in women.

Novel targeted bladder drug-delivery systems: a review

The objective of pharmaceutics is the development of drugs with increased efficacy and reduced side effects. Prolonged exposure of the diseased tissue to the drug is of crucial importance. Drug-delivery systems (DDSs) have been introduced to control rate, time, and place of release. Drugs can easily reach the bladder through a catheter, while systemically administered agents may undergo extensive metabolism. Continuous urine filling and subsequent washout hinder intravesical drug delivery (IDD). Moreover, the low permeability of the urothelium, also described as the bladder permeability barrier, poses a major challenge in the development of the IDD. DDSs increase bioavailability of drugs, therefore improving therapeutic effect and patient compliance. This review focuses on novel DDSs to treat bladder conditions such as overactive bladder, interstitial cystitis, bladder cancer, and recurrent urinary tract infections. The rationale and strategies for both systemic and local delivery methods are discussed, with emphasis on new formulations of well-known drugs (oxybutynin), nanocarriers, polymeric hydrogels, intravesical devices, encapsulated DDSs, and gene therapy. We give an overview of current and future prospects of DDSs for bladder disorders, including nanotechnology and gene therapy.

Quality assurance in quality of life assessment--measuring the validity of the King's Health Questionnaire.

Introduction and hypothesisThe King’s Health Questionnaire (KHQ) is a disease-specific, self-administered questionnaire designed to assess the impact of urinary incontinence on quality of life (QOL) in women. To our knowledge there are no data on women’s perception of completing the KHQ. Do they feel the KHQ to be useful and valuable or do they feel it to be too burdensome to be used in clinical practice? Therefore, we designed this study to evaluate patients’ perception of the KHQ using QQ-10. The QQ-10 is a validated tool designed to measure patient’s views on questionnaires.MethodsThis was a prospective observational study conducted at a tertiary referral teaching hospital. Patients were recruited from a one-stop urodynamics clinic. The study participants were asked to complete QQ-10 to give their views regarding KHQ. This produces two responses: positive value (communication, relevance, ease of use, comprehensiveness, enjoyableness, willingness to repeat) and negative burden (over-long, embarrassing, complicated, and upsetting). Mean scores and standard deviation for positive and negative responses were calculatedResultsThe KHQ was found to have a high mean value (73; range 13–100) and a low mean burden (25; range 0–81) regarding responses to individual QQ-10 items. This was reinforced by the positive comments provided in the text boxes.ConclusionsWomen perceived the KHQ as a valuable tool in their assessment without being bothersome.