1. Evaluation of the 2 x 24hour voiding diary
THE Concept of and first experiences with a new, non-invasive tool for diagnosis and follow up of IC/BPS patients
Evaluation of the 2 x 24hour voiding diary
THE GAG-LAYER INTEGRITY TEST
Sandor LOVASZ MD. PhD.
Hungary, Semmelweis Medical University, Budapest
ESSIC Annual Meeting
Philadelphia, June 13-15, 2014

2. A noninvasive diagnostic tool for BPS/IC
Pathogenesis of BPS/IC:
Abnormal epithelial permeability, epithelial leak, increased potassium absorption…
Corrupted GAG layer integrity /insufficiency
Emerging need of objective and quantitative testing of GAG layer integrity (uncertain and difficult diagnosis)
Parsons CL.: J Urol, 1998

3. A noninvasive diagnostic tool for BPS/IC
Potassium sensitivity test (PST) - Parsons test
Sensitivity – 69,5%
Specificity – 50% (Chambers GK et al: J Urol 1999)
Invasive (catheterization, bladder filling twice, painful, non- quantitative: yes or no)
Absence of potassium sensitivity in normal controls
Not used as a routine clinical test in monitoring of BPS/IC treatment efficacy.
Parsons CL.: Urology. 2001

4. A noninvasive diagnostic tool for BPS/IC
Modified potassium sensitivity-test (0,2M KCl)
Comparing C (max) using Saline vs. Potassium solution
Painless examination yet invasive and time consuming
(catheterization + repeated cystometry)
Cut off value at 30% growth
Non-quantitative (=> or <30%)
Although theoretically capable of quantitative measurement - clinically rarely used
Daha LK, Riedl CR et al: Eur Urol 2005

5. A noninvasive diagnostic tool for BPS/IC
Our observation is based on anamnestic data of 106 BPS/IC patients:
Symptoms usually worsen in summer period
Increased liquid consumption leads to remarkably reduced symptoms (pain, urgency)
Is there a role of concentration of urine?
Can these observations be used for quantitative testing?

6. A noninvasive diagnostic tool for BPS/IC
We asked patients to make a voiding diary by recording total urine volume and average urine portion
One patient recorded these data over 14 consecutive days from misunderstanding.

8. A noninvasive diagnostic tool for BPS/IC
Another sample of a 15 day voiding diary

9. A noninvasive diagnostic tool for BPS/IC
The 2 x 24 hour voiding diary
Patients were asked to calculate and record
Average daily urine portion
24 hours full urine volume
Throughout 2 consecutive days
Day 1 - max 800ml drinking (max. concentrated)
Day 2 - min 3000ml fluid intake (max. diluted)
The growth of mean daily urine portion was observed

10. A noninvasive diagnostic tool for BPS/IC

11. A noninvasive diagnostic tool for BPS/IC

12. A noninvasive diagnostic tool for BPS/IC

13. A noninvasive diagnostic tool for BPS/IC

14. A non-invasive diagnostic tool for BPS/IC

15. A noninvasive diagnostic tool for BPS/IC

16. A noninvasive diagnostic tool for BPS/IC
5 healthy volunteers:
Vol. constant
Our hypotheses
(based on these observations)
There is a linear correlation between total urine volume (concentration of urine) and average portion
The rate of change in average portion corresponds to severity of symptoms in IC/PPS
Average urine portion is constant in healthy people, independently from urine volume (concentration)
DVol. : 20-50%
DVol. : %

17. Continuous follow up on the website

18. Continuous follow up
on the website

19. Continuous follow up
on the website

20. Continuous follow up
on the website

21. Continuous follow up
on the website

22. Continuous follow up on the website
Impressive correlation between
- IC symptoms
- Changes of mean urine portions
By proving this correlation we could get a test for GAG layer integrity
Noninvasive
Painless
Quantitative
Not bound to the presence of investigator
Suitable for diagnostic purposes
Appropriate for long term follow up

23. A noninvasive diagnostic tool for BPS/IC
We are seeking for partners for a prospective, multicenter clinical trial
To collect pre- and post-treatment data of IC/BPS patients and
To statistically prove correlation between
Quantitatively measurable values of
Symptoms and GAG integrity-test.