Intravesical treatments for painful bladder syndrome/interstitial cystitis
Interstitial cystitis is also known as painful bladder syndrome. It typically causes symptoms of bladder and pelvic pain, an increased urge to pass urine and excessive urination during both day and night. The cause of the condition is not well-understood but it is thought to result from long-standing inflammation of the bladder. Many treatments have been used for PBS/IC and in this review we assess the effects of putting medication directly into the bladder (bladder instillations) to treat it. We found nine studies that addressed this question, assessing six different types of treatment and involving 616 participants. For none of the instillations was the evidence conclusive. It was most promising for BCG (a type of tuberculosis bacterium) and possibly also for oxybutinin (a drug commonly taken orally to stop unwanted bladder contractions). Another agent, Resiniferatoixin, seemed to worsen pain and increase the likelihood of patients stopping treatment early. Little evidence was found for assessing benefits and harms of other treatments instilled into the bladder.
Available from: urofrance.org
- "Une revue de la Cochrane Database a été réalisée et publiée par Dawson et Jamison , en 2007. Ils ont retenu neuf études randomisées ou quasi-randomisées comprenant au total 616 patients ayant un syndrome douloureux vésical/cystite interstitielle traité par des instillations endovésicales . "
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ABSTRACT: IntroductionPainful bladder syndrome is defined as chronic pelvic pain present for more than 6 months, causing discomfort perceived as being related to the bladder and accompanied by a persistent and strong urge to urinate or urinary frequency. The purpose of this article is to review the treatment of painful bladder syndrome.Material and methodsA comprehensive review of the literature was performed by searching PUBMED for articles on specific treatments for painful bladder syndrome.ResultsMany treatments have been proposed for the management of painful bladder syndrome: local intravesical treatments (glucosaminoglycan [pentosan polysulfate], dimethylsulfoxide [DMSO], heparin, bacillus Calmette-Guérin [BCG], anticholinergic agents [oxybutynin, etc.] or oral treatments [glucosaminoglycan (pentosan polysulfate), antihistamines, antidepressants, immunosuppressives, etc.]) with an action on the pathophysiology of this syndrome. The efficacy of these various treatments has been limited, with trials based on small numbers of patients and not always conducted according to a randomized, prospective design. Other salvage treatments (neuromodulation, botulinum toxin, surgery, etc.) have also been reported with limited efficacy, but allowing salvage of treatment failures.Conclusion
The therapeutic management of painful bladder syndrome is complex. The large number of proposed treatment modalities present a limited efficacy with discordant results from one study to another making comparisons and analyses difficult.
Available from: John Stoffel
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ABSTRACT: Purpose: We evaluated the effectiveness of combining behavioral therapy, pharmacologic therapy and endoscopic hydrodistension for treating painful bladder syndrome / interstitial cystitis (PBS/IC). Materials and Methods: Twenty-five patients with PBS/IC were prospectively enrolled in a pilot multimodal behavioral, pharmacologic and endoscopic treatment protocol. Behavioral modification included diet recommendations, fluid restriction to 64 oz. /day, progressive timed voiding and Kegel exercises. Oral pharmacologic therapy consisted of daily doses of macrodantin 100 mg, hydroxyzine 10-20 mg and urised 4 tablets. Patients underwent endoscopic bladder hydrodistention under anesthesia at least 2 weeks after protocol enrollment. Behavioral and pharmacological treatments were continued after the hydrodistention. O'Leary-Sant questionnaire scores were recorded before starting the protocol, after pharmacologic/behavioral therapy, 2 months post-hydrodistension, and at scheduled follow-up. Results: Eighteen patients (72%) completed the pilot multimodal treatment protocol and were followed for a mean of 10.2 months. All patients were female with a median age of 36.3 years and had mean bladder capacity under anesthesia of 836 milliliters. Mean O'Leary-Sant symptom index scores for baseline symptoms, after behavioral/pharmacologic treatment, post-hydrodistension and during follow up were 12.5, 8.6, 7.0, and 6.7 (p < 0.05). Mean O'Leary-Sant problem index scores for baseline, after behavioral/pharmacologic treatment, post-hydrodistention and during follow up were 12.7, 8.9, 6.7, and 7.7 (p < 0.05). Conclusion: Our pilot multimodal protocol of behavioral modification, pharmacologic therapy and endoscopic hydrodistention demonstrated a significant progressive improvement in PBS/IC quality of life scores, compared to a pre-treatment baseline. These results should be validated in a larger, placebo controlled trial.
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ABSTRACT: To describe the pathophysiology, diagnosis and controversies surrounding the diagnosis and pharmacological treatments of painful bladder syndrome/interstitial cystitis (PBS/IC) in children, we reviewed adult and paediatric literature pertaining to PBS/IC. Paediatric PBS/IC presents similarly to adult PBS/IC. The diagnosis is made by exclusion. Paediatric PBS/IC patients complain most commonly of urinary frequency, and abdominal pain occurs in up to 88% of affected children. Enuresis may also be a presenting complaint. Urinalysis and urine cultures are unremarkable. Management of paediatric PBS/IC is similar to that of adult PBS/IC, and non-surgical management includes dietary, lifestyle and pharmacological therapy. Pharmacological options include pentosan polysulfate, amitriptyline, hydroxyzine, cimetidine or intravesical therapies (dimethyl sulfoxide or 'therapeutic solution').
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