Interstitial Cystitis Versus Detrusor Overactivity: A Comparative, Randomized, Controlled Study of Cystometry Using Saline and 0.3 M Potassium Chloride

Philip, Joe; Willmott, Sasithorn; Irwin, Paul

doi:10.1016/s0022-5347(05)00238-7

Cited by 29 publications

(13 citation statements)

References 18 publications

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“…The results were the same; all patients with IC had reduced bladder capacities when exposed to potassium [20]. These same researchers tested both patients with OAB and those with IC and the potassium reactions were all positive in both groups [20,23]. In their discussion they felt the potassium might be directly affecting the muscle of the bladder, causing the reduced capacity they observed, and was probably due to an epithelial leak of the potassium.…”

Section: Potassium Sensitivity In Symptomatic Patient Populationsmentioning

confidence: 89%

“…Patients with IC were tested and compared with asymptomatic control subjects. To date, the international literature contains over 35 published reports on potassium testing in over 3000 patients with IC/painful bladder syndrome (PBS) and the data are very robust, with 80% of patients with IC testing positive [19–25]. Furthermore, several reports included data on about 200 normal subjects and the test was negative in 98.3%[14,18,26,27].…”

Section: The Role Of Urinary Potassium In the Generation Of Bladder Smentioning

confidence: 99%

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The role of a leaky epithelium and potassium in the generation of bladder symptoms in interstitial cystitis/overactive bladder, urethral syndrome, prostatitis and gynaecological chronic pelvic pain

2010

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What’s known on the subject? and What does the study add? This article reviews entirely new concepts concerning the etiology, presentation and diagnosis of interstitial cystitis. It pulls the information together in a concise fashion that emphasizes there is a radical change taking place in the concepts of what generates bladder symptoms. Primarily this emphasizes that the paradigm for interstitial cysititis and the generation of bladder symptoms is going to change dramatically. The data reviewed shows that the symptoms are caused by a leaky epithelium and subsequent diffusion of potassium into the tissues causing frequency, urgency, pain and incontinence. This is totally different from current concepts. The traditional diagnosis of interstitial cystitis (IC) only recognizes the severe form of the disease. The far more common early and intermittent phases of the disease are not perceived to be part of IC but rather are misdiagnosed as urinary tract infection, urethral syndrome, overactive bladder, chronic prostatitis, urethritis, or a type of gynecologic pelvic pain (such as endometriosis, vulvodynia, or some type of vaginitis). All of these patient groups actually suffer from the same bladder disease. This disease results from a leaky bladder epithelium and subsequent potassium leakage into the bladder interstitium that generates the symptoms of frequency, urgency, pain or incontinence in any combination. Robust scientific data now support this important concept. These data will be reviewed herein. The conclusions derived from these data substantially alter the paradigms for urology and gynecology in the generation of frequency, urgency and pelvic pain. All the above‐mentioned syndromes unite into one primary disease process, lower urinary dysfunction epithelium, or LUDE disease, and not the 10 plus syndromes traditionally recognized.

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Section: Potassium Sensitivity In Symptomatic Patient Populationsmentioning

confidence: 89%

Section: The Role Of Urinary Potassium In the Generation Of Bladder Smentioning

confidence: 99%

The role of a leaky epithelium and potassium in the generation of bladder symptoms in interstitial cystitis/overactive bladder, urethral syndrome, prostatitis and gynaecological chronic pelvic pain

2010

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“…In addition, it also suggests that patients with irritative bladder symptoms, whatever the precise cause, have bladder urothelia that are permeable to potassium. In another study, we investigated this further by directly comparing the CMGs obtained in patients with known DO with those of patients diagnosed as having IC [Philip et al, 2006].…”

Section: Discussionmentioning

confidence: 99%

A double‐blind, randomized controlled trial of cystometry using saline versus 0.3 M potassium chloride infusion in women with overactive bladder syndrome

Philip

Willmott

Owen

et al. 2006

Neurourology and Urodynamics

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Aim: To evaluate the e¡ect of 0.3 M potassium chloride on cystometric parameters by comparing it with normal saline as a ¢lling solution in women with overactive bladder (OAB). Patients and Methods: Twenty-three women with signi¢cant OAB symptoms underwent consecutive cystometrograms (CMGs) using 0.9% normal saline (NS) and 0.3 M potassium chloride (KCl), the order of which was randomized for each patient. Individual CMGs were performed by separate investigators and both patients and investigators were blinded to the order in which each solution was given and to the results of the other CMG. Results: Regardless of the nature of the ¢lling solution, the order in which the CMGs were performed had little in£uence on either ¢rst desire to void (FDV, mean 83.5 ml vs. 117.8 ml for ¢rst and second CMGs respectively, P ¼ 0.10) or on maximum cystometric capacity (Cmax, mean 265.0 ml vs. 264.4 ml, P ¼ 0.98). KCl produced a signi¢cant (24%) reduction in mean Cmax compared to NS (mean 228.6 ml vs. 300.8 ml, P ¼ 0.001), irrespective of the order of infusion. Conclusion: This comparative study using 0.3 M KCl versus NS as ¢lling solutions suggests that intravesical potassium may not simply act on urothelial sensory nerve endings; it may also stimulate detrusor muscle contraction. These ¢ndings may in£uence the interpretation of the potassium sensitivity test in patients with OAB symptoms, particularly in those suspected of having interstitial cystitis.

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“…15 However, Phillip and colleagues 40 found a more pronounced reduction in maximum CMG capacity with potassium chloride in the detrusor overactivity group compared with the IC group, suggesting a poor positive predictive value for the CCT in distinguishing IC from DO.…”

Section: Urodynamics (Not Recommended)mentioning

confidence: 98%

Diagnosis of interstitial cystitis

Carr

Corcos

Nickel

et al. 2013

CUAJ

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Interstitial Cystitis Versus Detrusor Overactivity: A Comparative, Randomized, Controlled Study of Cystometry Using Saline and 0.3 M Potassium Chloride

Abstract: The 0.3 M KCl reduces Cmax in IC and DO, the effect being more pronounced in DO. Urothelial hyperpermeability is not specific to IC. Comparative cystometry using NS and 0.3 M KCl does not help to differentiate IC from DO.

Cited by 29 publications

References 18 publications

The role of a leaky epithelium and potassium in the generation of bladder symptoms in interstitial cystitis/overactive bladder, urethral syndrome, prostatitis and gynaecological chronic pelvic pain

The role of a leaky epithelium and potassium in the generation of bladder symptoms in interstitial cystitis/overactive bladder, urethral syndrome, prostatitis and gynaecological chronic pelvic pain

A double‐blind, randomized controlled trial of cystometry using saline versus 0.3 M potassium chloride infusion in women with overactive bladder syndrome

Diagnosis of interstitial cystitis

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