Interstisyel Sistit Hastalarının Mesanelerindeki Sinir Boyanma Yoğunluğunun İdrar Sinir Büyüme Faktörü (Ngf= Nerve Growth Factor) Düzeyi ve Hastalık Semptom Skoru ile Korelasyonu

Abstract

Interstitial cystitis/ Bladder Pain Syndrome (IC/BPS) is a challenging disease effect millions of people around the world. It presents with suprapubic pain, frequency, urgency and dysuria but there are not any definitive diagnoses and treatment modalities yet. In this original study, we aim to assess the role of nerve fibers and nerve growth factor (NGF) in IC/BPS etiopathology and to demonstrate if there is a correlation between bladder nerve staining concentration, NGF and symptom severity. Thus, there might be no reason for unnecessary, expensive and troublesome tests and treatments. A prospective clinical study was conducted between March 2014 and February 2015 with 15 IC/BPS patients and 18 controls after local ethics committee approval. İnformed consent was obtained from patients and control subjects. Bladder biopsies were obtained from 15 IC/BPS patients and 9 controls. Midstream clean- catch urine specimens were collected from all patients and controls for urine NGF and creatinine measurements. O'Leary Sant İnterstitial Cystitis symptom and problem index was used to asses symptom severity and affects of the disease on patient life. Biopsies fixed in formalin were sectioned to 5-μ thicknesses and stained with S-100 immune histochemical dye. Patients and controls were classified into 3 groups as no staining, mild staining and obvious staining by an experienced urologic pathologist according to bladder nerve fiber staining concentration. The mean age of the IC/BPS patients was 52 years, while that of the control group was 46.9. There was no significant difference between the two groups (p>0.5). S-100 staining was negative 7 (%29.2) of 24 patients of those 1 of them was IC/BPS patient and the remaining 6 were controls. Mild staining was demonstrated in 10 IC/BPS patients as well as obvious staining was shown in 4 IC/BPS patients. Mean urine NGF levels normalized to the urine Cr level (NGF/Cr) in IC/BPS patients were significantly higher than that in controls, 0,34726 ±0,225 and 0,09434±0,0813, respectively (p<0.001). The mean symptom score in IC patients was 12.27±2.4 as well as the mean problem score was 10.9±2.3. The nerve fiber staining concentration and NGF/Cr level in IC/BPS patients were significantly correlated with O'Leary Sant IC symptom (p=0.024 and p=0.001, respectively) and problem index (p=0.010 and p=0.028, respectively) scores independently. But no correlation was found between nerve staining concentration and NGF/Cr levels. This may be due to low patient volume in each group. This is the first study in the literature, showing the importance of nerve fiber staining and urine NGF levels in IC/BPS patients and their effects on symptom and problem index scores. The role of nerve system and related neuropeptides and neurotrophins in IC/BPS pathogeneses cannot be ruled out. NGF could be use as a useful biomarker both for the diagnosis and assessment of symptom and problem severity. Because of the low patient number and limited current evidence more large, controlled and randomized trials are mandatory.