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INTRODUCTION AND HYPOTHESIS: Painful bladder syndrome (PBS) is frequently associated with deep endometriosis (DE), and both conditions cause chronic pelvic pain (CPP), which often impairs sleep quality. This study was aimed at analyzing the impact of CPP plus PBS in women with DE on the global sleep quality index using the Pittsburgh Sleep Quality Index (PSQI) and subsequently examine each sleep dimension. METHODS: One hundred and forty women with DE were included and answered the PSQI and the O'Leary-Sant Interstitial Cystitis Symptoms and Problem Index questionnaires with or without CPP. Women were categorized into good or poor sleepers using the PSQI cutoff; subsequently, a linear regression model was used to analyze the PSQI score and a logistic regression model for each questionnaire's sleep component. RESULTS: Only 13% of women with DE had a good sleep. Approximately 20% of those with DE but no/mild pain were good sleepers; 138 women with DE (88.5%), 94% with PBS, and 90.5% with moderate/severe pain were poor sleepers. For PSQI components, CPP worsened the subjective sleep quality by more than threefold (p = 0.019), increased sleep disturbances by nearly sixfold (p = 0.03), and decreased the sleep duration by practically sevenfold (p = 0.019). Furthermore, PBS increased sleep disturbances by nearly fivefold (p < 0.01). CONCLUSIONS: The addition of PBS to CPP in women with DE is devastating for overall sleep quality, probably because it impacts some sleep dimensions unaffected by CPP and amplifies the problem in those already affected by pain.

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Objetivo: este estudio busca describir los hallazgos cistoscópicos en un grupo de pacientes con dolor pélvico crónico (DPC) que consultaron a una clínica de referencia en Pereira (Colombia). Materiales y métodos: es un estudio de corte transversal en mujeres que consultaron la clínica en el período comprendido entre julio de 2006 y octubre de 2008, por dolor pélvico crónico a una institución hospitalaria de 4° nivel y centro de remisión; y que fueron sometidas a laparoscopia y cistoscopia. Por medio de un formulario se extrajeron los datos de las historias clínicas. También se describe la prevalencia de cistitis intersticial y trigonitis crónica. Resultados: 115 mujeres con DPC fueron sometidas a laparoscopia y cistoscopia bajo anestesia general. El 59% de las pacientes tenían hallazgos cistoscópicos de cistitis intersticial. Los síntomas de frecuencia urinaria aumentada, disuria y nicturia tuvieron una correlación estadísticamente significativa con los hallazgos anormales en la cistoscopia. El principal signo hallado en el examen físico fue el dolor al palpar la vejiga. El test de cloruro de potasio tuvo una sensibilidad del 71%, una especificidad del 44%, un Valor Predictivo Positivo (VPP) del 60% y un Valor Predictivo Negativo (VPN) del 57%. Conclusiones: en pacientes con dolor pélvico crónico y síntomas urinarios se encuentra una alta prevalencia de cistitis intersticial y trigonitis crónica...

Objective: this study was aimed at describing cystoscopy findings in a group of patients suffering from chronic pelvic pain (CPP) who had consulted at a reference clinic in Pereira, Colombia. Materials and methods: a cross-sectional study was made of females who had consulted for CPP at a level 4 hospital and referral center between July 2006 and October 2008 and who had then undergone laparoscopy and cystoscopy. Data was extracted from their clinical histories using a tailor-made form. Interstitial cystitis and chronic trigonitis prevalence were described. Results: 115 females suffering from CPP underwent laparoscopy and cystoscopy under general anesthetic; 59% of the patients had positive cystoscopy findings for interstitial cystitis. Increased urinary frequency, dysuria and nicturia symptoms had a statistically significant correlation with abnormal cystoscopy findings. The main sign found in their physical examination was pain on palpating the bladder. The potassium chloride test had 71% sensitivity and 44% specificity, with 60% positive predictive value (PPV) and 57% negative predictive value (NPV). Conclusions: a high prevalence of interstitial cystitis and chronic trigonitis was found in patients suffering from chronic pelvic pain and urinary symptoms...

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PURPOSE: Interstitial cystitis/painful bladder syndrome (IC/PBS) is characterized by chronic pain, pressure and discomfort felt in the pelvis or bladder. An in-depth shotgun proteomics study was carried out to profile the urinary proteome of women with IC/PBS to identify possible specific proteins and networks associated with IC/PBS. MATERIALS AND METHODS: Urine samples from ten female IC/PBS patients and ten female asymptomatic, healthy control subjects were analyzed in quadruplicate by liquid chromatography-tandem mass spectrometry (LC-MS/MS) on a hybrid linear ion trap-orbitrap mass spectrometer. Gas-phase fractionation (GPF) was used to enhance protein identification. Differences in protein quantity were determined by peptide spectral counting. RESULTS: a-1B-glycoprotein (A1BG) and orosomucoid-1 (ORM1) were detected in all IC/PBS patients, and = 60 percent of these patients had elevated expression of these two proteins compared to control subjects. Transthyretin (TTR) and hemopexin (HPX) were detected in all control individuals, but = 60 percent of the IC/PBS patients had decreased expression levels of these two proteins. Enrichment functional analysis showed cell adhesion and response to stimuli were down-regulated whereas response to inflammation, wounding, and tissue degradation were up-regulated in IC/PBS. Activation of neurophysiological processes in synaptic inhibition, and lack of DNA damage repair may also be key components of IC/PBS. CONCLUSION: There are qualitative and quantitative differences between the urinary proteomes of women with and without IC/PBS. We identified a number of proteins as well as pathways/networks that might contribute to the pathology of IC/PBS or result from perturbations induced by this condition.

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