GENERAL APPROACH TO TREATMENT

ORAL TREATMENT | Double-blind randomized placebo-controlled studies

 

  • Randomized, double-blind, dose-ranging study of pentosan polysulfate sodium for interstitial cystitis
    Nickel JC, Barkin J, Forrest J, et al. Urology 2005;65:654-8
    • three dosages (300, 600, and 900 mg) of PPS in a randomized, double-blind, double-dummy, parallel-group, multicenter, 32-week study were studied in 380 IC patients
    • at study end, 27.5%, 56.9%, and 15.7% reported mild, moderate, and severe symptoms, respectively
    • for all three dosages of PPS, a clinically significant but similar response was demonstrated; the duration of therapy appears to be more important than the dosage

  • Pilot study of sequential oral antibiotics for the treatment of interstitial cystitis
    Warren JW, Horne LM, Hebel JR, et al. J Urol 2000;163:1685-8
    • 50 patients with IC were randomized to receive 18 weeks of placebo or antibiotics, including rifampin plus a sequence of doxycycline, erythromycin, metronidazole, clindamycin, amoxicillin and ciprofloxacin for 3 weeks each. 
    • 12 of 25 patients (48%) in the antibiotic and 6 of 25 (24%) in the placebo group reported overall improvement (p = 0.14), while 10 and 5, respectively, noticed improvement in pain and urgency (p = 0.22). 
    • in the antibiotic group 20 participants (80%) had adverse effects compared with 10 (40%) in the placebo group (p = 0.009). 
    • the authors conclude that their findings suggest that these antibiotics alone or in combination may sometimes be associated with decreased symptoms in some patients but they do not represent a major advance in therapy for interstitial cystitis

  • A prospective double-blind clinically controlled multicenter trial of sodium pentosanpolysulfate in the treatment of interstitial cystitis and related painful bladder disease
    Holm-Bentzen M, Jacobsen F, Nerstrom B, et al. J Urol 1987;138:503-7 
    • protocol A included 43 patients with clinically and pathologically anatomically verified interstitial cystitis (28 or more mast cells per mm.2) 
    • protocol B included 72 patients with a painful bladder and unspecific histological findings 
    • patients were randomized to receive either sodium pentosanpolysulfate (200 mg. twice daily) or placebo capsules for 4 months 
    • before and after the trial the patients were evaluated with symptom grading, urodynamics and cystoscopy with distension and deep bladder biopsies 
    • the results showed no difference between the pre-trial and post-trial values in the sodium pentosanpolysulfate and placebo groups in both protocols in regard to symptoms, urodynamic parameters, cystoscopic appearance and mast cell counts. 
    • a significant increase in the cystoscopically determined bladder capacity in the sodium pentosanpolysulfate group in protocol A was found 
    • the authors conclude that no statistically or clinically significant effect of sodium pentosanpolysulfate was found compared to placebo in patients with painful bladder disease

 

Open studies and non-placebo-controlled studies

 

 

Case Reports

 

INTRAVESICAL TREATMENT

 

  • Treatment of interstitial cystitis with Cystistat: a hyaluronic acid product
    Kallestrup EB, Jorgensen SS, Nordling J, Hald T. Scand J Urol Nephrol 2005;39:143-7 
    • in this prospective, unblinded, uncontrolled pilot study, 20 patients with IC/PBS received weekly bladder instillations of hyaluronic acid for 1 month and monthly instillations for a further 2 months
    • patients were then offered further monthly instillations and all were subsequently evaluated after 3 years 
    • patient outcomes assessed were urinary frequency, use of analgesics and pain 
    • the authors conclude that hyaluronic acid safely reduced the pain and, to lesser degree, the urinary frequency associated with IC

Case Reports

  • [Intravesical instillation of resiniferatoxin for the patients with interstitial cystitis] [article in Japanese] 
    Takahashi S, Yanase M, Inoue R, et al. Hinyokika Kiyo 2006;52:911-3 
    • resiniferatoxin (RTX) treatment was given to 3 patients with incomplete improvement after hydrodistention; all 3 patients were free of bladder pain posttreatment and had slight improvement of the maximum voided volume
    • the authors conclude that although RTX treatment required general anaesthesia against severe bladder pain it is effective for selected IC patients

Reviews

NEUROMODULATION TREATMENT

  • Bilateral s3 stimulator in patients with interstitial cystitis
    Steinberg AC, Oyama IA, Whitmore KE. Urology 2007;69:441-3
    • this retrospective study demonstrated that 15 patients diagnosed with interstitial cystitis with the symptoms of frequency, urgency, and pain had a significant decrease in frequency and nocturia with bilateral stimulator placement

SURGICAL TREATMENT (UNDER CONSTRUCTION)

OTHER TREATMENT

Hyperbaric oxygen

 

Hydrodistension

 

OVERVIEW OF RANDOMIZED-CONTROLLED TRIALS WITH BENEFICIAL EFFECT

Oral treatment

  • Randomized, double-blind, dose-ranging study of pentosan polysulfate sodium for interstitial cystitis
    Nickel JC, Barkin J, Forrest J, et al. Urology 2005;65:654-8
    • three dosages (300, 600, and 900 mg) of PPS in a randomized, double-blind, double-dummy, parallel-group, multicenter, 32-week study were studied in 380 IC patients
    • at study end, 27.5%, 56.9%, and 15.7% reported mild, moderate, and severe symptoms, respectively
    • for all three dosages of PPS, a clinically significant but similar response was demonstrated; the duration of therapy appears to be more important than the dosage

 

Intravesical treatment

  • Safety and Efficacy of the Use of Intravesical and Oral Pentosan Polysulfate Sodium for Interstitial Cystitis: A Randomized Double-Blind Clinical Trial
    Davis EL, El Khoudary SR, Talbott EO, et al. J Urol 2007 Nov 12; [Epub ahead of print]
    • 41 females diagnosed with IC were randomized to receive a combination of intravesical pentosan polysulfate sodium plus oral pentosan polysulfate sodium or intravesical placebo plus oral pentosan polysulfate sodium for 6 weeks; all subjects continued to receive oral pentosan polysulfate sodium for another 12 weeks
    • at week 18 the treatment group showed statistically significant improvement in all quality of life scores, while the placebo group showed significant improvement in only 3 quality of life scores compared to the baseline

TREATMENT OF BPS