İnterstisyel Sistit Etiyolojisinde Mikrobiyolojik Araştırmanın Yeri

Abstract

Interstitial cystitis / Bladder Pain Syndrome (IC/BPS) is a complex clinical condition and its etiology is not well understood yet, considering many etiological factors including lower urinary tract infections. Patients who has irritative lower urinary tract symptoms (urgency, frequency, nocturia, disuria) with urethral/pelvic pain for more than 6 weeks. The prevelance of IC/BPS is 4-5 times more common in women than men. The economic burden of IC/BPS is undeniable and millions of people admit to outpatient clinics for treatment of this condition. The new microbiologic diagnostic tools are promising in the diagnosis of IC/BPS. Special urine cultures with higher sensitivity to detect a pathogen may decrease the treatment costs and increase psychosocial health of the patients. This prospective clinical study was performed on 26 IS/BPS patients ( 25 female 1 male) and 20 controls after the approval of ethics committee between April 2017 and September 2017 . Informed consent was obtained from patients and control subjects. The mean age of the IC/BPS patients was 45,5 years and was 36,5 in the control group (p<0.05). Regardless of the previous treatments either oral or intravesical, patients who are still symptomatic and complaining of nocturia, urgency, frequency and pain during the last 30 day were evaluated with “O’Leary Sant Symptom and Problem Index” scoring. The study group (n:26) were asked to give sterile mid stream urine sample for routine urine culture, urine yeast culture and urine tuberculosis culture. Followed by the results, symptomatic 26 patients were asked to be evaluated with a cystoscopy under local or general anesthesia. Biopsies has been taken from the suspicious mucosal lesions in the bladder. 24 of 26 patients had a suspicous cystoscopy findings which required for biopsy. Urine and biopsy samples were investigated for both L-forms in cultures and for sexually transmitted disease pathogens in Rt-PCR . Meanwhile 20 mid stream sterile urine samples were collected from the control group without any bladder biopsy. The urine and biopsy samples were inoculated into %5 sheep blood agar and EMB agar urine culture mediums. Also samples were inoculated to GYPA and SDA for investigational purposes of any yeast colonies existance. LEM and PG liquid mediums were used to investigate L-form microorganisms. At the end of 24 hour incubation of urine and biopsy samples in the PG medium under 35-37 0C in case of any blurring was seen on the 2th day, inocululation to blood, EMB, LEM and GYPA mediums were performed. All urine and biopsy samples of patients in the PG medium were re-inoculated to blood, EMB, LEM and GYPA at the day 10. The same microorganisms were reported after inoculation to blood, GYPA, EMB and LEM at the day 2 and 10. A total number of 13 patients with positive culture results: 9(60%) of the samples with P.aeruginosa 105 cfu/ml (one with C.mucifaciens, one another with E.faecalis co-existance), 2(13%) of the samples with K.pneumonia 105 cfu/ml, 2(13%) of the samples with C.mucifaciens 105 cfu/ml and 1(7%) sample with E.faecalis 105 cfu/ml were reported. U.parvum was detected on the Rt-PCR result of one patient with a positive culture of P.aeruginosa ve E.faecium co-existance. 11 of 20 controls and 5 of 26 patient urine samples had positive Rt-PCR results. There was a significant difference between the two groups (p:0.01). Considered as a pathogen regarding to 1.-2.-10. day incubation results, those microorganisms re-inoculated and proliferated in the PG liquid medium were passed through a 0.2µm por filter . The filtered samples were inoculated to blood, EMB, LEM and GYPA to demonstrate L-form existance but none of them were alive. In the fact that L-form existance of such microorganism still can not be ruled out because of negative routine urine culture results. There were no significant correlations between the cystoscopy and culture results. In conclusion more special and pathogen based culture mediums should be used in cases with IC/BPS. The incubation periods and standart intervals can be modified according to underlying rare microorganisms. Randomized controlled trials on large patient populations are mandatory for future IC/BPS studies.