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Pediatric urology
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Laurel Sofer, Emilie K. Johnson
Pentosan polysulfate (PPS) is the only FDA-approved medical therapy for IC/PBS, but it has not been studied in children. Hydroxyzine is an antihistamine that is safe for use in children. The combination of PPS plus evening hydroxyzine may be a safe starting point for moderate symptoms of IC/PBS in adolescent females.
Miscellaneous: Dextran, Dermatan Sulfate, Low Molecular Weight Heparinoids (Org 10172), Pentosan Polysulfate (Sp54), Defibrinating Agents (Ancrod And Reptilase)
Published in Hau C. Kwaan, Meyer M. Samama, Clinical Thrombosis, 2019
M. M. Samama, P. C. Desnoyers, H. C. Kwaan
Pentosan polysulfate is a semisynthetic compound obtained by sulfation of pentosan extracted from beechwood.34–37 It has a low molecular weight composed of 5 to 6 kDa with 17 to 26 subunits of xylopyranose residues. It has been given to man parenterally and is slowly eliminated after subcutaneous injections. The peak level is obtained 1 to 3 h after subcutaneous injections with 70% bioavailability. It is mainly excreted by the kidney with one third of the dose found in urine over 3 d.34 It possesses anticoagulant activity which is mainly dependent on heparin cofactor II, and inhibits Factor Xa activity more than Factor IIa.35,38 It could induce increase in fibrinolytic activity by the release of tissue plasminogen activator from vessel wall. Its profibrinolytic activity is greater than that of heparin. It could influence the contact-phase fibrinolytic activation of plasminogen.36,37 Hemker showed that it also could play a role in the activation of Factors V and VIII activation by thrombin.37
Interstitial Cystitis
Published in Gary W. Jay, Practical Guide to Chronic Pain Syndromes, 2016
Neel Shah, Hossein Sadeghi-Nejad, Robert Moldwin
One of the most popularized theories of IC pathogenesis is a defect of the bladder’s mucosal lining (36). Normally, the bladder is highly impermeable to urine and its constituents based upon its complex histology and the bladder mucin that lines its surface. The bladder surface mucin is composed of proteoglycans and glycoproteins and is often referred to as the glycosaminoglycan or “GAG” layer. Compared to controls, patients with IC had absorbed significantly more urea after bladder instillation of concentrated urea (15). Studies have also shown that patients with IC have decreased urinary GAG excretion and bladder biopsies revealing disrupted GAG arrangement (37). Absorption of various urinary constituents such as potassium and urea in the face of bladder surface mucin abnormalities has been speculated to cause nerve stimulation and other downstream inflammatory events. Further support for this theory is that administration of pentosan polysulfate sodium (PPS), a synthetic compound similar to GAG, often alleviates patients’ symptoms (38).
Ocular adverse effects of bladder medication: a systematic review
Published in Cutaneous and Ocular Toxicology, 2022
Arshpreet Bassi, Daiana Roxana Pur, Anthony Chifor, Monali S. Malvankar-Mehta
Overactive bladder syndrome (OAB) and interstitial cystitis (IC) are significantly increasing in prevalence with the ageing population. OAB and IC have similar LUTS, including urinary urgency/frequency, incontinence, and nocturia5. The key symptom in OAB is urgency, however, nocturia is commonly reported as the most bothersome. OAB is most common in patients over 40 years old, however, the various factors contributing to disease varies from individual to individual. The aetiology is not well understood but there have been multiple theories to explain the pathophysiology. Overall, all theories refer to detrusor overactivity related to the reduction in inhibitory neural impulses or increased sensitisation to cholinergic stimulation6. The most common medications used to manage symptoms of OAB are Fesoterodine, Oxybutynin, Solifenacin, Tolterodine, Tropsium, and Mirabegron6. IC shares many symptoms with OAB, with the addition of pain7. The pathophysiology of IC is still under investigation, however, there is a consensus that there is underlying damage in the mucosal lining that triggers the chronic inflammatory state7. Pentosan Polysulfate is a medication commonly used as pharmacotherapy for IC.
Neuro-Ophthalmic Literature Review
Published in Neuro-Ophthalmology, 2022
David A. Bellows, John J. Chen, Jenny A. Nij Bijvank, Michael S. Vaphiades, Xiaojun Zhang
Pentosan polysulphate sodium (PPS), a semisynthetic sulphated polysaccharide, is the only Federal Drug Administration-approved oral therapy for interstitial cystitis. The authors reviewed all publications concerning PPS maculopathy to consolidate known clinical features and to evaluate the strength of this association. Initial symptoms may include prolonged dark adaptation and difficulty reading with relative visual acuity preservation. Fundus examination often shows macular pigment clumps corresponding to lesions of focal retinal pigment epithelial (RPE) thickening. Fundus auto-fluorescence most clearly depicts the condition, with a distinctive pattern of hypo- and hyper-autofluorescent spots in the posterior pole that sometimes extends to the retinal periphery. Many cases also show a characteristic peripapillary hypo-autofluorescent halo. Near infrared reflectance may aid in early detection. RPE atrophy, cystoid macular oedema, and macular neovascularisation may also occur, potentially resulting in loss of central acuity. The authors concluded that this newly described association implies significant public health risk and ophthalmologists should screen PPS users with multimodal retinal imaging, and prescribers should minimsze dose and duration of PPS use.
Comparative safety review of current pharmacological treatments for interstitial cystitis/ bladder pain syndrome
Published in Expert Opinion on Drug Safety, 2021
Po-Yen Chen, Wei-Chia Lee, Yao-Chi Chuang
Pentosan polysulfate (PPS), consists of synthetic sulfated polysaccharide GAG-like molecule, which can bind to the GAG layer for replenishment and anti-inflammation for the injured bladder wall. It is the only FDA approved oral treatment agent and it is one of the most studied drugs for the treatment of IC/BPS. In a recent systematic review and meta-analysis, six randomized placebo-controlled studies were included and it was proven to diminish symptom scores, bladder pain, urinary frequency, and urgency. Furthermore, a 12.4% difference treatment response rate between PPS and placebo treatment was also mentioned [26]. As for dose efficacy, the recommended doses are 100 mg three times daily. In a previous study, similar clinical response increased over time was demonstrated in patients received 300 mg, 600 mg, 900 mg daily, which indicated the treatment duration is more important than the treatment dosage [27].