Cimetidine in painful bladder syndrome: a histopathological study

Citation
P. Dasgupta et al., Cimetidine in painful bladder syndrome: a histopathological study, BJU INT, 88(3), 2001, pp. 183-186
Citations number
15
Categorie Soggetti
Urology & Nephrology
Journal title
BJU INTERNATIONAL
ISSN journal
14644096 → ACNP
Volume
88
Issue
3
Year of publication
2001
Pages
183 - 186
Database
ISI
SICI code
1464-4096(200108)88:3<183:CIPBSA>2.0.ZU;2-B
Abstract
Objective To determine whether oral cimetidine. which reportedly improves s ymptoms in 60-70% of patients with painful bladder syndrome/interstitial cy stitis has a similar mechanism of action on the human bladder and involving a similar peptidergic pathway as it has in human stomach, where it alters histamine-gastrin reactions mediated via H-2 receptors and a proton pump. Patients and methods Fourteen patients (13 women and one man, mean age 51 y ears) with refractory bladder pain and irritative urinary symptoms were tre ated with cimetidine. The response to cimetidine was assessed by outpatient follow-up and an analogue pain score. Bladder biopsies from eight patients were stained with haematoxylin and eosin, and a polyclonal antibody to gas trin, with counterstaining using toluidine blue, to detect mast cell granul es containing histamine. Biopsies from normal areas of the bladder from an age-matched control group of patients with transitional cell carcinoma of t he bladder were stained similarly. Human stomach and colon were used as pos itive controls for gastrin and toluidine blue, respectively. The clinical r esponse to cimetidine was compared with the histology in a blinded fashion. Results Eight of the patients responded well to cimetidine: none of the bio psies showed evidence of carcinoma in situ. Although G cells in the stomach stained well for gastrin none of the bladder biopsies showed gastrin-like immunoreactivity, apart from some non-specific urothelial staining. Numerou s mast cells with crimson granules and pale nuclei were visible in three pa tients and fewer in three others: their presence or absence did not correla te with the symptomatic response. Conclusions Cimetidine is a useful medical treatment for bladder pain but t he presence or absence of gastrin or histamine-like immunoreactivity does n ot explain its therapeutic benefit.