How to manage a patient with chronic cystitis and a negative UroVysion (Fluorescence In Situ Hybridization) FISH assay result?

From the Guidelines

Management of chronic cystitis with a negative UroVysion FISH assay result should focus on symptom relief and addressing underlying causes, as the negative result helps exclude urothelial carcinoma but does not explain persistent symptoms. The approach should include a thorough reassessment of the diagnosis, considering other potential causes of chronic cystitis.

First-Line Treatment

• If infection is suspected, first-line treatment includes antibiotics, typically a 7-14 day course of trimethoprim-sulfamethoxazole (Bactrim DS 1 tablet twice daily), nitrofurantoin (Macrobid 100mg twice daily), or fluoroquinolones based on urine culture results 1.
• For non-infectious cystitis, consider pentosan polysulfate sodium (Elmiron 100mg three times daily) to repair bladder lining, amitriptyline (10-75mg at bedtime) for pain management, or hydroxyzine (10-25mg at bedtime) for allergic components.

Behavioral Modifications

• Increased water intake (2-3 liters daily) is essential to help flush out the bladder and reduce symptom severity.
• Avoiding bladder irritants such as caffeine, alcohol, and spicy foods can also help alleviate symptoms.
• Pelvic floor physical therapy may be beneficial in some cases to help manage symptoms and improve bladder function.

Refractory Cases

• For refractory cases, consider bladder instillations with dimethyl sulfoxide (DMSO), heparin, or lidocaine solutions.
• Regular follow-up every 3-6 months is recommended to monitor symptoms and adjust treatment as necessary 1. This approach addresses both symptom management and potential underlying causes while ensuring that malignancy has been appropriately excluded by the negative FISH assay.

From the FDA Drug Label

To reduce the development of drug-resistant bacteria and maintain the effectiveness of sulfamethoxazole and trimethoprim oral suspension and other antibacterial drugs, sulfamethoxazole and trimethoprim oral suspension should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. Urinary Tract Infections For the treatment of urinary tract infections due to susceptible strains of the following organisms: Escherichia coli, Klebsiella species, Enterobacter species, Morganella morganii, Proteus mirabilis and Proteus vulgaris

The patient has chronic cystitis without hematuria and a negative UroVysion FISH assay result. The UroVysion FISH assay is used to detect genetic alterations associated with bladder cancer. Given the negative result, the focus should be on managing the chronic cystitis.

• The clinical indication is other chronic cystitis without hematuria.
• The specimen type is urine.
• Trimethoprim/sulfamethoxazole can be used to treat urinary tract infections due to susceptible strains of certain organisms, but the patient's specific infection cause is not specified.
• In the absence of culture and susceptibility information, local epidemiology and susceptibility patterns may contribute to empiric selection of therapy 2. It is recommended to consider the patient's overall clinical presentation and obtain culture and susceptibility information to guide antibiotic therapy.

From the Research

Management of Patient with Chronic Cystitis and Negative UroVysion FISH Assay Result

• The patient has a negative UroVysion FISH assay result, which suggests that there is no evidence of chromosomal abnormalities consistent with bladder cancer 3.
• However, a negative FISH result does not exclude low-grade urothelial neoplasia, especially in patients with a history of chronic cystitis 4.
• The patient's clinical indication is other chronic cystitis without hematuria, which may increase the risk of developing bladder cancer 5.
• Studies have shown that UroVysion FISH assay is more sensitive than urine cytology for detecting bladder cancer, but it has a lower specificity 5, 3.
• In patients with a negative FISH result, the risk of recurrence is lower, but it is still important to continue surveillance and monitoring 6, 7.
• The patient's management plan should include regular follow-up cystoscopies and urine cytology tests to monitor for any changes or abnormalities 4, 5.
• It is also important to consider the patient's overall clinical situation and medical history when interpreting the FISH result 4, 7.

Surveillance and Monitoring

• Regular surveillance and monitoring are crucial for patients with a history of chronic cystitis and a negative UroVysion FISH assay result 6, 7.
• The frequency and type of surveillance tests may vary depending on the patient's individual risk factors and medical history 5, 7.
• Patients with a positive FISH result or atypical cytology are more likely to recur and may require more frequent surveillance and monitoring 7.
• The goal of surveillance is to detect any changes or abnormalities early, when they are more easily treatable 4, 5.

Clinical Implications

• A negative UroVysion FISH assay result does not necessarily mean that the patient is cancer-free, and continued surveillance and monitoring are necessary 4, 5.
• The patient's clinical indication and medical history should be taken into account when interpreting the FISH result and developing a management plan 4, 7.
• Regular follow-up appointments and surveillance tests can help to detect any changes or abnormalities early, improving patient outcomes 5, 7.