{"id":18096,"date":"2022-10-28T08:58:48","date_gmt":"2022-10-28T08:58:48","guid":{"rendered":"https:\/\/urosassociats.com\/factores-crecimiento-en-el-sindrome-de-dolor-vesical-sdv\/"},"modified":"2026-01-26T13:08:57","modified_gmt":"2026-01-26T13:08:57","slug":"factores-crecimiento-en-el-sindrome-de-dolor-vesical-sdv","status":"publish","type":"post","link":"https:\/\/urosassociats.com\/ca\/factores-crecimiento-en-el-sindrome-de-dolor-vesical-sdv\/","title":{"rendered":"Factors creixement en la s\u00edndrome de dolor vesical (SDV)"},"content":{"rendered":"
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Les s\u00edndromes de dolor vesical (SDV) constitueixen una patologia cr\u00f2nica dolorosa, incapacitant i debilitant d’etiologia desconeguda, diagn\u00f2stic complex i tractament freq\u00fcentment desenraonat. Hi ha diverses teories que intenten explicar el seu origen i els s\u00edmptomes que provoquen. No hi ha cap exploraci\u00f3 ni an\u00e0lisi que permeti arribar de manera clara al seu diagn\u00f2stic, per\u00f2 en aproximadament un 10% de les ocasions es detecta per endosc\u00f2pia urin\u00e0ria (cistosc\u00f2pia) una lesi\u00f3 caracter\u00edstica que es denomina Lesi\u00f3 de Hunner i \u00e9s diagn\u00f2stica de cistitis intersticial (CI).<\/p>\n

La CI \u00e9s una malaltia inclosa dins del cat\u00e0leg de malalties rares. Tradueix una s\u00e8rie de canvis inflamatoris cr\u00f2nics severs similars als que es troben en altres malalties sist\u00e8miques com les malalties autoimmunes o les malalties reum\u00e0tiques, per\u00f2 amb afectaci\u00f3 espec\u00edfica de la bufeta que pateix un deteriorament sever amb despreniment del seu recobriment i augment de la permeabilitat. L’orina \u00e9s rica en elements t\u00f2xics que indueixen inflamaci\u00f3 i dolor i cronifiquen el quadre perqu\u00e8 tenen un augment de la destrucci\u00f3 cel\u00b7lular i la incapacitat d’induir un recanvi adequat per noves c\u00e8l\u00b7lules madures que restableixin la funci\u00f3 de barrera i impermeabilitzaci\u00f3.<\/p>\n

La lesi\u00f3 de Hunner nom\u00e9s \u00e9s la manifestaci\u00f3 puntual d’una malaltia global de la bufeta i el seu tractament requereix l’eliminaci\u00f3 d’aquesta lesi\u00f3, tot i que el risc que apareguin de nou \u00e9s alt, circumst\u00e0ncia que passa en un per\u00edode mitj\u00e0 de 8 mesos.<\/p>\n

El 90 % dels pacients amb SDV que no presenten lesi\u00f3 de Hunner no solen mostrar canvis inflamatoris tan evidents com en el que s\u00ed que presenten lesi\u00f3 de Hunner i el dolor sembla relacionat amb un trastorn en la permeabilitat de la bufeta i una disfunci\u00f3 de la transmissi\u00f3 de la sensibilitat en els nervis i en el sistema nervi\u00f3s central.<\/p>\n

El tractament d’aquestes s\u00edndromes doloroses segueix un algoritme que inclou analg\u00e8sics simples o derivats m\u00f2rfics de pot\u00e8ncia progressiva, antidepressius i antiepil\u00e8ptics d’efecte modulador del dolor, instilaci\u00f3 de diferents f\u00e0rmacs dins de la bufeta mitjan\u00e7ant una sonda (\u00e0cid hialur\u00f2nic, condroit\u00ed sulfat, DMSO, corticoides o anest\u00e8sics), injecci\u00f3 de toxina botul\u00ednica, neuromodulaci\u00f3 el\u00e8ctrica i en alguns casos, immunosupresures com la ciclosporina A. En els casos m\u00e9s greus que no responen a cap tractament nom\u00e9s es pot rec\u00f3rrer a l’ extracci\u00f3 de la bufeta malalta.<\/p>\n<\/div>\n<\/div><\/div>\n\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n\n

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En els \u00faltims anys ve obtenint-se evid\u00e8ncies sobre la utilitat del plasma aut\u00f2leg enriquit amb plaquetes (PRP) i l’\u00fas de c\u00e8l\u00b7lules mare en les malalties degeneratives i inflamat\u00f2ries cr\u00f2niques en diferents \u00f2rgans i teixits del nostre organisme.<\/p>\n

Hi ha estudis en models animals i algun estudi en humans sobre la utilitat del plasma enriquit amb plaquetes (PRP) en el tractament de la s\u00edndrome de dolor vesical. Els resultats resulten esperan\u00e7adors at\u00e8s que s’ha publicat un \u00edndex de fins a un 70% de pacients despr\u00e9s de 4 injeccions intravesicals (1 cada mes). Aquesta millora es va mantenir en controls posteriors. L’\u00fanic estudi publicat en humans es va realitzar en pacients sense lesi\u00f3 de Hunner, per\u00f2 l’experi\u00e8ncia no publicada recolza la teoria que la millora \u00e9s m\u00e9s important i prolongada en els pacients amb lesi\u00f3 de Hunner, on hi ha una base inflamat\u00f2ria severa.<\/p>\n

Les plaquetes s\u00f3n riques en factors de creixement i estan implicades en la inducci\u00f3 d’ un nou proc\u00e9s inflamatori<\/u> que porta a una reparaci\u00f3 m\u00e9s r\u00e0pida i efectiva. Indueix proliferaci\u00f3 cel\u00b7lular i migraci\u00f3 cap al teixit danyat, promovent la diferenciaci\u00f3 i maduraci\u00f3 cel\u00b7lular i l’angiog\u00e8nesi (estimulaci\u00f3 de nous vasos sanguinis).<\/p>\n

\u00c9s important en la reparaci\u00f3 urotelial, augmentant el nombre de fibroblasts i c\u00e8l\u00b7lules musculars llises, promovent l’oxigenaci\u00f3 i la remodelaci\u00f3 posterior tissular. Aquests efectes, juntament amb altres factors de creixement com l’ EGF, promou la regeneraci\u00f3 del uroteli danyat i contraresta la fibrosi conseq\u00fc\u00e8ncia de la malaltia.<\/p>\n<\/div>\n<\/div><\/div>\n\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n\n

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El PRP tamb\u00e9 es pot aplicar per tractar ulceres t\u00f2rpides aix\u00ed com el dolor neurop\u00e0tic perqu\u00e8 promou la regeneraci\u00f3 neuronal. Facilita la regeneraci\u00f3 axonal i per tant modula els senyals dolorosos aberrants procedents de la bufeta.<\/p>\n

Aix\u00ed mateix disminueix el nombre d’episodis de cistitis bacterianes perqu\u00e8 millora la barrera urotelial i preveu el dany provocat per bacteris uropat\u00f2genes<\/p>\n

El tractament es realitza en quir\u00f2fan en r\u00e8gim ambulatori (sense ingr\u00e9s) i amb sedaci\u00f3 o anest\u00e8sia intradural. Pr\u00e8viament, el mateix dia del procediment, s’extreu sang del pacient i se n’a\u00eflla i concentra el seu plasma que s’enriqueix amb les seves pr\u00f2pies plaquetes. En el moment de la injecci\u00f3 aquest plasma s’activa qu\u00edmicament i immediatament despr\u00e9s s’injecta en diferents punts de la bufeta.<\/p>\n

Aquest tractament es repeteix un total de 4 vegades (1 cada mes) segons aconsella l’evid\u00e8ncia publicada. Hi ha algun estudi recent (2022) que mostra una millora significativa amb un tractament \u00fanic, per\u00f2 els resultats s\u00f3n clarament inferiors als obtinguts amb la repetici\u00f3 del tractament, almenys, 3 vegades.<\/p>\n

Com qualsevol procediment invasiu, t\u00e9 algun risc de complicaci\u00f3. No obstant aix\u00f2 aquestes complicacions no s\u00f3n majors que les associades a qualsevol altra intervenci\u00f3 endosc\u00f2pica menor. Com a conseq\u00fc\u00e8ncia de la introducci\u00f3 d’ un instrument endosc\u00f2pic i la punci\u00f3 amb agulla en diversos punts de la bufeta, es pot produir un dolor passatger, sensaci\u00f3 de desig miccional persistent, encara amb la bufeta buida, sagnat lleu o infecci\u00f3. Molt rarament el sagnat pot ser m\u00e9s intens i requerir la col\u00b7locaci\u00f3 d’una sonda amb rentat durant unes hores. Previ al procediment s’ administra un antibi\u00f2tic preventiu que haur\u00e0 de continuar durant uns dies m\u00e9s. No es produeixen reaccions al producte injectat at\u00e8s que s’ obt\u00e9 de la sang del mateix pacient.<\/p>\n

El tractament amb c\u00e8l\u00b7lules mare en el dolor vesical es troba encara en fase d’investigaci\u00f3 i nom\u00e9s es realitza en el context d’assajos cl\u00ednics controlats i no constitueixen actualment una opci\u00f3 est\u00e0ndard de tractament.<\/p>\n

Dr. Eduardo Vicente Palacio<\/strong>
\nUros Associats<\/em><\/p>\n<\/div>\n<\/div><\/div>\n\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":3,"featured_media":17369,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[267],"tags":[268,269,270],"class_list":["post-18096","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-dolor-vesical","tag-dolor-vesical","tag-factors-de-creixement","tag-plaquetas-ca"],"yoast_head":"\nFactors de creixement en el SDV vesical – Uros Associats<\/title>\n<meta name=\"description\" content=\"Funci\u00f3 dels factors de creixement en el s\u00edndrome de dolor vesical (SDV) i el seu paper en el tractament i alleujament dels s\u00edmptomes.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" 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