Etiology, pathogenesis, and diagnosis of interstitial cystitis. Increased risk of bladder cancer following diagnosis with bladder pain syndrome/interstitial cystitis. Safety and dose flexibility clinical evaluation of intravesical liposome in patients with interstitial cystitis or painful bladder syndrome. Effect of intravesical glycosaminoglycan substitution therapy on bladder pain syndrome/interstitial cystitis, bladder capacity and potassium sensitivity Impact of intravesical hyaluronic acid and chondroitin sulfate on bladder pain syndrome/interstitial cystitis A prospective, double‐blind, randomized cross‐over study evaluating changes in urinary pH for relieving the symptoms of interstitial cystitis Combined intravesical sodium hyaluronate/chondroitin sulfate therapy for interstitial cystitis/bladder pain syndrome: a prospective study Intravesical hyaluronic acid for interstitial cystitis/painful bladder syndrome: a comparative randomized assessment of different regimens. A Pilot Open Label Study of Cystoprotek® in Interstitial Cystitis A placebo-controlled study of intravesical pentosanpolysulphate for the treatment of interstitial cystitis. A combined intravesical therapy with hyaluronic acid and chondroitin for refractory painful bladder syndrome/interstitial cystitis Intravesical hyaluronic acid and alkalinized lidocaine for the treatment of severe painful bladder syndrome/interstitial cystitis Intravesical alkalinized lidocaine (PSD597) offers sustained relief from symptoms of interstitial cystitis and painful bladder syndrome Treatment of interstitial cystitis with Cystistat®, A hyaluronic acid product Improvement of interstitial cystitis symptoms and problems that developed during treatment with oral IPD-1151T. Psychometric validation of the O'leary-Sant interstitial cystitis symptom index in a clinical trial of pentosan polysulfate sodium. Successful downregulation of bladder sensory nerves with combination of heparin and alkalinized lidocaine in patients with interstitial cystitis.
Interstitial cystitis ( IC ) is a bladder syndrome of unknown etiology . The cause of IC is most likely multifactorial and includes genetic and environmental factors . Various pathophysiological changes in the bladder , pelvis , and peripheral and central nervous systems have been identified , and this has led to the emergence of biologically specific treatment modalities . Interstitial cystitis is being diagnosed with increasing frequency ; however , current diagnostic criteria are non-uniform , and there is significant overlap between chronic pelvic pain syndromes in men and women , interstitial cystitis , recurrent " cystitis , " and the overactive bladder syndrome . The diagnosis of interstitial cystitis can be made clinical ly and by cystoscopy and hydrodistension . The sensitivity and specificity of urinary markers and the potassium sensitivity test have not been prospect ively studied AIMS Interstitial cystitis/bladder pain syndrome ( IC/BPS ) is a prevalent disorder that may contribute to bladder cancer ( BC ) . This cohort study set out to investigate the association between IC/BPS and BC by using a population -based data set . METHODS The data for this study were source d from the Taiwan National Health Insurance program . The case cohort comprised 7,562 patients with IC/BPS , and 22,686 r and omly selected subjects were used as a comparison cohort . A Cox proportional hazards regression model ( stratified by age group , geographic location , urbanization level , and the index year ) was constructed to estimate the risk of subsequent BC following a diagnosis of IC/BPS . We also ran the analysis utilizing an alternative comparison cohort composed of patients with urinary incontinence ( UI ) . RESULTS In the study sample of 30,248 patients , 96 patients ( 0.32 % ) received a diagnosis of BC during the 3-year follow-up period ; 48 ( 0.63 % of patients with IC/BPS ) were from the study cohort ; and 48 ( 0.21 % of patients without IC/BPS ) were from the comparison cohort . The incidence rate of BC was 2.12 ( 95 % CI : 1.58 - 2.78 ) per 1,000 person-years in patients with IC/BPS and 0.70 ( 95 % CI : 0.52 - 0.92 ) per 1,000 person-years in comparison patients . Cox proportional analysis revealed that the adjusted HR for BC during the 3-year follow-up period for patients with IC/BPS was 2.95 ( 95 % CI : 1.97 - 4.41 ) that of comparison subjects . When performing the analysis with the alternative UI comparison cohort , the adjusted HR for BC was 1.96 ( 95 % CI : 1.14 - 3.39 ) . CONCLUSIONS This investigation detected a novel association between BC and prior IC/BPS To present single institution open-label experience with intravesical liposomes ( LPs ) , a mucosal protective agent , in patients with interstitial cystitis/painful bladder syndrome ( IC/PBS ) and to assess the safety and efficacy on IC/PBS symptoms . A total of 17 symptomatic IC/PBS patients were treated with intravesical LPs ( 80mg/40mL distilled water ) once a week for 4 weeks ( n=12 ) or twice a week treatment for 4 weeks ( n=5 ) . The primary outcome was the change in the O'Leary-Sant Symptom/Problem score and O'Leary-Sant total Score from baseline to Week 4 and Week 8 . Other outcome measurements included the changes in pain scale , urgency scale , voiding log , and patient global assessment . Both weekly and biweekly LP instillation regiments were well tolerated . The incidence of urinary incontinence , retention , or unanticipated adverse changes was not noted at any dose either during the treatment or at the 4-week follow-up . The O'Leary-Sant Symptom/Problem score , O'Leary-Sant total Score , and pain score were significantly improved from baseline at both dose regimens with added benefit with the biweekly regimen . Intravesical LPs treatment is safe and its efficacy has sustained duration . Furthermore large-scale , placebo-controlled studies are warranted to assess the efficacy for this promising new treatment for IC/PBS Objective . To evaluate changes in bladder capacity and potassium sensitivity after glycosaminoglycan ( GAG ) substitution therapy . Material and methods . The study population comprised two groups of female patients with bladder pain syndrome/interstitial cystitis ( BPS/IC ) : responders ( those with symptom improvement ) and non-responders ( those without symptom improvement ) after a 10-week period of intravesical , episodic , weekly , GAG substitution therapy . A total of 27 volunteers with increased pre-therapeutic potassium sensitivity were enrolled in the study and re-evaluated using the modified comparative potassium test ( maximal bladder capacity with a saline solution versus a 0.2 M KCl solution ) following intravesical GAG substitution therapy . Results . In the 13 responders , the average maximal bladder capacity increased by 17 % with the saline solution and by 101.5 % with the 0.2 M KCl solution . In the 14 non-responders , post-therapeutic average maximal bladder capacity was decreased by 35 % with the saline solution and remained relatively unchanged after instillation with a 0.2 M KCl solution . Conclusion . These data demonstrate that in patients who respond symptomatically to intravesical GAG substitution therapy , cystometric bladder capacity is increased , whereas non-responders experience a decrease in bladder capacity Introduction and hypothesisIntravesical instillations of hyaluronic acid ( HA ) and chondroitin sulfate ( CS ) may lead to regeneration of the damaged glycosaminoglycan layer in interstitial cystitis/bladder pain syndrome ( IC/BPS ) . Methods Twenty-two patients with IC/BPS received intravesical instillations ( 40 ml ) of sodium HA 1.6 % and CS 2.0 % in 0.9 % saline solution ( IALURIL ® , IBSA ) once weekly for 8 weeks , then once every 2 weeks for the next 6 months . Results The score for urgency was reduced from 6.5 to 3.6 ( p = 0.0001 ) , with a reduction in pain scores from an average of 5.6 to 3.2 ( p = 0.0001 ) . The average urine volume increased from 129.7 to 162 ml ( p < 0.0001 ) , with a reduction in the number of voids in 24 h , from 14 to 11.6 ( p < 0.0001 ) . The IC Symptom and Problem Index decreased from 25.7 to 20.3 ( p < 0.0001 ) , and the Pain Urgency Frequency score , from 18.7 to 12.8 ( p < 0.0001 ) . Conclusion The treatment appeared to be effective and well tolerated in IC/BPS in this initial experience To provide evidence for the clinical efficacy of changes in urinary pH on the pain associated with interstitial cystitis ( IC ) Objectives : The aim of this study was to verify the efficacy and safety of intravesical treatment combining sodium hyaluronate ( HA ) and chondroitin sulfate ( CS ) in patients with interstitial cystitis/bladder pain syndrome ( IC/BPS ) . Methods : Between February 2010 and May 2011 , 20 consecutive women with IC/BPS were treated with intravesical instillations containing sodium HA ( 1.6 % ; 800 mg/50 ml ) and sodium CS ( 2 % ; 1 g/50 ml ) weekly for the first month , biweekly for the second month , and then monthly for at least 3 months . Before and after treatment , all patients filled in the Interstitial Cystitis Symptom Index and Problem Index ( ICSI/ICPI ) , the Patient Health Question naire 9 and the Pelvic Pain and Urgency/Frequency Patient Symptom Scale ( PUF ) . Treatment efficacy was assessed by comparing the pre- and post-treatment mean scores of the three question naires using Student ’s t test ( p value < 0.05 was considered significant ) . Results : Statistically significant mean decreases in ICSI ( from 13.0 to 9.3 ; p = 0.0003 ) , ICPI ( from 11.35 to 8.85 ; p = 0.0078 ) and PUF ( from 20.0 to 15.75 ; p = 0.0007 ) question naire scores were seen . No cases of side effects or complications were observed . The mean follow up was 5 months . Conclusions : Despite the limitations of this study , the outcomes confirmed the role of combination therapy with HA and CS as a safe and effective option for the treatment of IC/BPS . Further r and omized controlled studies with a higher number of patients and a longer follow-up period are needed to confirm these results OBJECTIVES To compare the clinical effectiveness of different regimens of intravesical hyaluronic acid instillation for patients with interstitial cystitis/painful bladder syndrome . METHODS A total of 60 patients ( age 16 - 77 years ) diagnosed with interstitial cystitis/painful bladder syndrome were enrolled in this prospect i ve , r and omized study . A total of 30 patients were assigned to receive four weekly intravesical instillations of 40 mg of hyaluronic acid followed by five monthly instillations ( hyaluronic acid-9 group ) . Another 30 patients received 12 intravesical instillations of 40 mg hyaluronic acid every 2 weeks ( hyaluronic acid-12 group ) . Symptomatic changes after hyaluronic acid treatments were assessed using Interstitial Cystitis Symptom and Problem Indexes , pain visual analog scale , functional bladder capacity , frequency and nocturia in voiding diary , maximum flow rate , voided volume , postvoid residual volume , and Quality of Life Index at 1 , 3 and 6 months . RESULTS Of the 60 patients , 59 were evaluable at the end of the study . The Interstitial Cystitis Symptom Index , Interstitial Cystitis Problem Index and total score , pain visual analog scale , functional bladder capacity , maximum flow rate , and Quality of Life Index improved significantly after 6 months in both groups . The frequency and voided volume improved significantly only in the hyaluronic acid-12 group . However , patients with moderate and marked improvement were clinical ly similar in both groups . The measured variables did not differ between the two groups over the course of the study . CONCLUSION No significant difference was noted in the therapeutic effect between two hyaluronic acid instillation regimens for treatment of interstitial cystitis/painful bladder syndrome patients . Both groups showed significant improvement in symptom scores and Quality of Life Index Interstitial cystitis ( IC ) is a disorder of the urinary bladder characterized by urgency , frequency , nocturia and suprapubic pain . IC occurs primarily in women and symptoms are exacerbated by stress , ovulatory hormones and certain foods . IC pathogenesis is unknown , but the most consistent findings involve some dysfunction of the bladder glycosaminoglycan ( GAG ) protective layer and a high number of activated bladder mast cells . There is no effective therapy even through intravesical administration of dimethylsulfoxide ( DMSO ) or oral pentosanpolysulfate ( PPS ) have had variable success . A dietary supplement , CystoProtek ® , was formulated with the natural GAG components chondroitin sulfate and sodium hyaluronate to provide urothelial cytoprotection , together with the flavonoid quercetin that has anti-inflammatory properties and inhibits activation of mast cells . Thirty-seven female patients diagnosed by the NIDDK criteria who had failed all forms of therapy  took six softgel CystoProtek ® capsules per day for 6 months . Global assessment scale was reduced from 9.0 ± 2.9 to 4.3 ± 2.1 ( p < 0.05 ) ; moreover , the O'Leary/Sant Symptom Index decreased from 16.3 ± 3.1 to 6.9 ± 4.2 ( p < 0.05 ) and the Problem Index from 13.1 ± 3.7 to 5.4 ± 4.0 ( p < 0.05 ) . These results are very promising and warrant a larger study that may permit further analyses with respect to other , especially atopic , comorbid diseases OBJECTIVE To evaluate the therapeutic efficacy of intravesical pentosanpolysulphate ( PPS ) compared with placebo in patients with interstitial cystitis ( IC ) . PATIENTS AND METHODS Twenty patients who fulfilled the diagnostic criteria for IC participated in a double-blind placebo-controlled study ; 10 received intravesical PPS ( 300 mg in 50 mL of 0.9 % sodium chloride ) applied twice a week for 3 months and the other 10 received a placebo .  Symptomatic relief and objective variables ( bladder capacity voiding volumes and urinary frequency ) were assessed after 3 months and the long-term outcome of those continuing treatment was determined . RESULTS Of the patients treated with PPS , four gained significant symptomatic relief compared with only two receiving placebo . Only the urodynamic bladder capacity showed a statistically significant increase in patients treated with PPS ( P = 0.047 ) . At 18 months from the start of the study , the symptoms were relieved in eight patients while still receiving PPS instillations and in four without treatment . CONCLUSIONS These results suggest that intravesical PPS is an effective option for the treatment of IC and shows that the intravesical application of PPS is a safe treatment with no important side-effects The aims of this study were to evaluate the efficacy and tolerability of intravesical instillations of high-molecular-weight hyaluronic acid ( HA ) 1.6 % and chondroitin sulfate ( CS ) 2.0 % in patients with refractory painful bladder syndrome/interstitial cystitis ( PBS/IC ) and to observe their impact on Quality of Life . Twenty-three women were enrolled . They received bladder instillations with HA and CS weekly for 20 weeks and then monthly for 3 months . Mean follow-up after completion of therapy was 5 months . We observed a significant improvement in urinary symptoms on voiding diaries and Visual Analogue Scale for frequency ( p = 0.045 ) , urgency ( p = 0.005 ) , and pain ( p = 0.001 ) . The O’Leary – Sant Interstitial Cystitis Symptom Index and Interstitial Cystitis Problem Index result ed in a significant improvement in both scores ( p = 0.004 and 0.01 , respectively ) . The Pelvic Pain and Urgency/Frequency Symptom Scale only showed significant improvement in the symptom score ( p = 0.001 ) . This promising experience seems to offer an additional therapeutic option in patients with refractory PBS/IC Introduction and hypothesisIntravesical instillation of hyaluronic acid ( HA ) may restore the integrity of glycosaminoglycan layer in patients with painful bladder syndrome/interstitial cystitis ( PBS/IC ) , and the benefit may be improved with addition of alkalinized lidocaine ( AL ) . Methods 48 women with severe PBS/IC who failed oral medications were enrolled and divided into one trial and two control groups . The trial group received intravesical 40 mg HA , 10 ml of 2 % lidocaine and 5 ml of 8.4 % sodium bicarbonate on a weekly basis for 8 weeks and then monthly for 4 months with a subsequent follow-up of 24 weeks , while the two control groups received 40 mg HA and mixture of 10 ml of 2 % lidocaine and 5 ml of 8.4%sodium bicarbonate respectively following the same procedure . Response to therapy was evaluated by Global Response Assessment , voids per day , Visual Analogue Scale for pain , frequency and urgency , O’leary-Sant Interstitial Cystitis Symptom Index and Problem Index , cystoscopy and bladder capacity . Results Overall 45 patients finished this study protocol . The HA + AL group and the AL group showed significant improvement at week 2 ( P < 0.01 ) , while the HA group began to show effect at week 4 ( P < 0.01 ) . There was no improvement in the AL group at week 24 and these patients quitted the study without follow up . Contrarily , the HA + AL and HA group kept on improving till the end of the study without significant difference between the two groups . Conclusions Intravesical instillation of HA and AL may provide both immediate and sustained relief of symptoms in severe PBS/IC in this preliminary study To assess the immediate and sustained relief of the symptoms of interstitial cystitis/painful bladder syndrome ( IC/PBlS ) after a consecutive 5‐day course of treatment with intravesical alkalinized lidocaine ( PSD597 ) , and to characterize the pharmacokinetics of single and multiple doses of intravesical PSD597 in a subgroup of patients Objective . To determine whether intravesical hyaluronic acid is effective in reducing the urinary frequency and pain associated with interstitial cystitis/painful bladder syndrome ( IC/PBS ) . Material and methods . In a prospect i ve , unblinded , uncontrolled pilot study , 20 patients ( age range 34–80 years ) , all suffering from 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 . Results . All patients completed the 3 months of hyaluronic acid treatment with mean decreases in nocturia and pain of 40 % and 30 % , respectively , and a decrease in analgesic use . Thirteen patients ( 65 % ) responded to treatment ( responders ) and continued therapy , while seven patients withdrew , six because of a lack of response and one due to cystectomy . In the 13 patients who continued hyaluronic acid instillations , four complete responders ( 30 % ) ceased therapy after a strong positive response ( 36 % , 60 % and 81 % decreases compared to baseline in day-time voids , night-time voids and pain scores , respectively ) which was maintained in the absence of continuous therapy , while after 3 years seven partial responders ( 35 % ) were still on therapy ( 25 % and 43 % decreases compared to baseline in day-time voids and pain scores , respectively ) . Two patients developed other diseases during follow-up and showed no response to long-term therapy . Hyaluronic acid was well tolerated by all patients . Conclusion . Hyaluronic acid safely reduced the pain and , to a lesser degree , the urinary frequency associated with IC PURPOSE We examined the efficacy of Suplatast Tosilatedouble dagger ( IPD-1151 T ) , a new immunoregulator that suppresses helper T cell mediated allergic responses , including IgE production and eosinophilic inflammation for treating patients with interstitial cystitis . MATERIAL S AND METHODS A total of 14 women ( average age 43.7 years ) with interstitial cystitis , which was nonulcerative in 13 and ulcerative in 1 , were treated with 300 mg . IPD-1151 T orally daily for 12 months . All patients received laboratory assessment s , including hematology ( eosinophils and CD20 positive cells ) and serum chemistry ( IgE , and interleukin-4 ( IL-4 ) and 5 , and immunohistochemical analyses of urine leukocytes ( CD45RO positive cells as a T cell marker ) before treatment . These parameters were also measured 4 and 12 months after continuous treatment . The voiding chart , and interstitial cystitis symptom and problem indexes were evaluated before and after IPD-1151 T treatment . RESULTS IPD-1151 T treatment for 1 year result ed in a significantly increased bladder capacity and decreased symptoms , such as urinary urgency , frequency and lower abdominal pain , in patients with nonulcerative interstitial cystitis . These effects also correlated with a reduction in blood eosinophils , CD20 positive cells and IgE , and urine CD45RO positive memory T cells . No major side effects were observed . CONCLUSIONS Our study suggests that immunological responses are involved in the development of interstitial cystitis symptoms . IPD-1151 T could be a new oral agent for treatment of voiding symptoms and bladder pain in patients with interstitial cystitis The O'Leary-Sant Interstitial Cystitis Symptom Index ( ICSI ) has been proposed as a treatment outcome measure in interstitial cystitis ( IC ) . The psychometric properties of the ICSI were assessed for reliability and validity in a r and omized , double-blind clinical study of 300 , 600 , and 900 mg daily dose of pentosan polysulfate sodium ( PPS ) in patients with IC . The ICSI contains 4 items that measure urgency and frequency of urination , nighttime urination , and pain or burning . The ICSI index score is the sum of the item scores ( range : 0 - 20 ) . ICSI scores were obtained at baseline , 4 , 8 , 12 , 16 , 24 , and 32 weeks of treatment . Patients ' overall ratings of improvement of symptoms ( PORIS ) scores evaluating improvements in pain , urgency , and overall IC symptoms were also collected except at baseline . A total of 376 patients were included in the analysis . Psychometric properties evaluated included variability ( range ) , test-retest reliability ( intraclass correlation coefficient [ ICC ] ) , internal consistency ( the Cronbach alpha ) , construct validity ( convergent , discriminant ) , responsiveness , and clinical ly meaningful change . The ICSI items and index score had good variability and test-retest reliability . The ICSI demonstrated internal consistency reliability and was responsive to change . Participants indicating a 75 % improvement in PORIS had a 48 % mean reduction in the ICSI score , while participants reporting 100 % improvement in PORIS had a 77 % mean reduction in the ICSI score . The ICSI is a valid , reliable , and responsive measure of change in IC symptoms . This outcome measure should be utilized in future treatment outcomes studies in IC OBJECTIVES To test the efficacy of a new intravesical therapeutic solution in relieving urgency/frequency and pain in interstitial cystitis ( IC ) . METHODS A solution of 40,000 U heparin , 8 mL 1 % lidocaine ( 80 mg ; group 1 ) or 2 % lidocaine ( 160 mg ; group 2 ) , and 3 mL 8.4 % sodium bicarbonate was administered intravesically in patients with newly diagnosed IC with significant frequency , urgency , and pain . Using the Patient Overall Rating of Improvement of Symptoms , the response to treatment was evaluated within 20 minutes of instillation in all patients , after 24 to 48 hours in group 2 , and after three treatments per week for 2 weeks in group 2 patients who elected to receive additional instillations . Significant symptom relief was defined as 50 % or greater symptom improvement . RESULTS After one instillation , 35 ( 75 % ) of 47 patients in group 1 ( 1 % lidocaine ) and 33 ( 94 % ) of 35 in group 2 ( 2 % lidocaine ) reported significant immediate symptom relief . The difference in the response rates was statistically significant ( P < 0.01 ) . In group 2 , 50 % of the subjects experienced at least 4 hours of symptom relief from the single instillation , and 16 ( 80 % ) of 20 reported significant sustained symptom relief after 2 weeks of treatment . CONCLUSIONS Intravesical treatment with combined heparin and alkalinized lidocaine immediately reduced the pain and urgency of IC in most patients treated for newly diagnosed IC . Symptom relief lasted beyond the duration of the local anesthetic activity of lidocaine , suggesting the solution suppresses neurologic upregulation . In IC treatment , this new intravesical solution may be helpful in the interval before heparinoid therapy reaches its full effect
HMW-HA was significantly superior in cost effectiveness and cost efficacy to all other instillation regimes .
Bladder pain syndrome/interstitial cystitis ( BPS/IC ) is a chronic disease characterised by persistent irritating micturition symptoms and pain .
The objective was to compare the clinical efficacy of currently available products for intravesical therapy of BPS/IC and to assess their pharmacoeconomic impact .