Cystitis Research Center

- Abstracts - Dr. Jean-Louis Durier -

Abstact Form
1995 Interstitial Cystitis Symposium
ANTI - ANAEROBIC ANTIBIOTIC USE IN CHRONIC INFLAMMATION. URGENCY - FREQUENCY. URGE INCONTINENCE & IN INTERSTITIAL CYSTITIS SYNDROMES.

J. L. Durier. University of Montreal & Toronto. Canada

Objective: Efficacy of Anti - Anaerobic Antibiotics (AAA s) in syndromes related to "Abacterial" Uretho - Vesical Inflammation & Interstitial Cystitis.

Method: 134 consecutive cases of women having symptoms of urgency-frequency (and negative urine culture) & pain triggered upon digital examination of either the urethra (77%) or the bladder (89%) had associated urge-incontinence (63%) or pelvi-genital pain or dyspareunia (52%). In the awake patients, 98% of 2nd look cystoscopies disclosed existing signs of inflammation with patches of pink discoloration (PPD) &/or glomerulations & among these, 20 cases fulfilled all NIH - criteria for Interstitial Cystitis.

Treatment: In spite of negative cultures, all referred patients had received common antibiotics without success. Thereafter, the treatment was started with the intake of the 1st AAA in an available series of 5 consecutive AAAs. If improvement was neither progressive nor existent with an AAA. Its substitution was done with the nest in the series, & so on, until symptoms and triggered signs of inflammation no longer existed. Intravenous (iv) route was used to rescue oral route failures & severe pain cases. Drop-out rate was 10.7% : mean months follow-up: 7.3% (1 - 17).

Results: 1st AAA: 50% cure, 2nd: 29%, 3rd: 7.4%, 4th: 2.5% & the (iv) route brought the global success rate up to 99.2%. Including the cases of Interstitial Cystitis. Mean treatment duration: 54 days. Epidemiology: at least 34% of sexual mates had similar clinical findings. Recurrence rate was 16.3%.

Conclusion: Persistent aaa treatment induced the simultaneous disappearance of triggered signs of inflammation (endoscopic & clinical) & pain, voiding irritability & sexual disorders. This suggests that hidden pathogens such as the anaerobes can generate a "chronic" inflammation which triggers urethro-vesico-sexual neurovegetative disorders which otherwise would not be curable without the AAAs.

ABSTRACT FORM
1995 Interstitial Cystitis Symposium
URETHRO - CYSTECTOMY WAS AVOIDED. ANOTHER REPORT OF 3 CASES OF INTERSTITIAL CYSTITIS SUCCESSFULLY TREATED WITH IV-ANTIBIOTICS COVERING THE SPECTRUM OF THE ANAEROBES.

J. L. Durier, A. Bruce, M. Mittelman. University of Toronto. Canada

Three patients, two women & one man that had been thoroughly investigated by several urologists in which the diagnosis of Interstitial Cystitis had been consistently made using NIH-criteria, were offered urethrocystectomy after all other conventional treatments had failed to relieve their crippling symptoms.

They were referred to our center where IV - antibiotherapy was attempted with metronidazole, erythromycin ÊÊÊ& clindamycin, as has been previously reported (1).

The first woman received only 5 days of treatment while waiting for her urethrocystectomy. Her bladder ÊÊ capacity increased progressively from 25cc to 65cc and her symptoms began to improve. Intraoperatively it was discovered that the inflammation of her urethra and trigone was gone and a conservative supratrigonal cystectomy with augmentation cystoplasty was done.

Encouraged by this result and before proceeding with surgery, the next two consecutive surgical cases of Interstitial Cystitis were offered a more extended course of iv-antibiotics. They both completely avoided surgery and have a normal like 9 months after therapy.

The treatment of these cases with the discussion of their symptomatic regression will be presented.

(1) The application of anti-anaerobic antibiotics to the treatment of female bladder dysfunction. Neurourology and Urodynamics. 11, 4: 418-419. 1992.

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