evaluation of the 2 x 24hour voiding diary sandor lovasz md. phd. hungary, semmelweis medical...
TRANSCRIPT
Evaluation of the 2 x 24hour voiding diary
Sandor LOVASZ MD. PhD.Hungary, Semmelweis Medical University, Budapest
ESSIC Annual MeetingPhiladelphia, June 13-15, 2014
THE GAG-LAYER INTEGRITY THE GAG-LAYER INTEGRITY TESTTEST
THE GAG-LAYER INTEGRITY THE GAG-LAYER INTEGRITY TESTTEST
Pathogenesis of BPS/IC:
Abnormal epithelial permeability, epithelial leak, increased potassium absorption…
Corrupted GAG layer integrity /insufficiency
Emerging need of objective and quantitative testing of GAG layer integrity (uncertain and difficult diagnosis)
Parsons CL.: J Urol, 1998
Potassium sensitivity test (PST) - Parsons test Sensitivity – 69,5%
Specificity – 50% (Chambers GK et al: J Urol 1999)
Invasive (catheterization, bladder filling twice, painful, non-quantitative: yes or no)
Absence of potassium sensitivity in normal controls
Not used as a routine clinical test in monitoring of BPS/IC treatment efficacy.
Parsons CL.: Urology. 2001
Modified potassium sensitivity-test (0,2M KCl) Comparing C (max) using Saline vs. Potassium solution
Painless examination yet invasive and time consuming
(catheterization + repeated cystometry)
Cut off value at 30% growth
Non-quantitative (=> or <30%)
Although theoretically capable of quantitative measurement - clinically rarely used
Daha LK, Riedl CR et al: Eur Urol 2005
Our observation is based on anamnestic data of 106 BPS/IC patients:
Symptoms usually worsen in summer period
Increased liquid consumption leads to remarkably reduced symptoms (pain, urgency)
Is there a role of concentration of urine?
Can these observations be used for quantitative testing?
We asked patients to make a voiding diary by recording total urine volume and average urine portion
One patient recorded these data over 14 consecutive days from misunderstanding.
Another sample of a 15 day voiding diary
Patients were asked to calculate and record
Average daily urine portion
24 hours full urine volume
Throughout 2 consecutive days
Day 1 - max 800ml drinking (max. concentrated)
Day 2 - min 3000ml fluid intake (max. diluted)
The growth of mean daily urine portion was observed
The 2 x 24 hour voiding diary
Our hypotheses(based on these observations)
There is a linear correlation between total urine volume (concentration of urine) and average portion
The rate of change in average portion corresponds to severity of symptoms in IC/PPS
Average urine portion is constant in healthy people, independently from urine volume (concentration)
5 healthy volunteers:
Vol. constant
www.bladderpain.eu
Continuous follow up on the website
Continuous follow up on the website
Continuous follow up on the website
Continuous follow up on the website
Continuous follow up on the website
Impressive correlation between - IC symptoms - Changes of mean urine portions
By proving this correlation we could get a test for GAG layer
integrity• Noninvasive • Painless • Quantitative • Not bound to the presence of investigator• Suitable for diagnostic purposes• Appropriate for long term follow up
Continuous follow up on the website
We are seeking for partners for a prospective, multicenter clinical trial
To collect pre- and post-treatment data of IC/BPS patients andTo statistically prove correlation betweenQuantitatively measurable values ofSymptoms and GAG integrity-test.