selected literature on intravesical treatment of PBS/IC
click on the title to jump to the abstract if available
Intravesical treatments for painful bladder syndrome/interstitial cystitis. Dawson T, Jamison J. Cochrane Database Syst Rev 2007 Oct 17;(4):CD006113 • Cochrane report on intravesical treatment for PBS/IC
• Evidence base for intravesical treatment is limited
• Quality of trial reports mixed
• BCG and oxybutynin reasonably well-tolerated; RTX showed no evidence of effect for most outcomes
• Little evidence for other treatments included in this review
• Randomised controlled trials and standardisation are still needed
Intravesical alkalinized lidocaine (PSD597) offers sustained relief from symptoms of interstitial cystitis and painful bladder syndrome. Nickel JC, Moldwin R, Lee S, Davis EL, et al. BJU Int 2008 Nov 13. [Epub ahead of print].PMID: 19021619
- the purpose of this preliminary study was to assess the immediate and sustained relief of the symptoms of IC/PBS after a consecutive 5-day course of intravesical alkalinized lidocaine (PSD597) and to characterize the pharmacokinetics of single and multiple doses of intravesical PSD597 in a subgroup of patients
- the authors concluded that this treatment was effective for providing sustained improvement of IC/PBS symptoms beyond the acute treatment phase
- the drug was safe, well-tolerated and devoid of the systemic side-effects often experienced with oral drugs
- long-term studies are needed to determine the optimum regimen to maintain this favourable treatment effect.
The efficacy of intravesical Tice strain bacillus Calmette-Guerin in the treatment of interstitial cystitis: a double-blind, prospective, placebo controlled trial. Peters K, Diokno A, Steinert B, et al. J Urol 1997;157:2090-4 • 30 subjects was enrolled in the study with a mean followup of 8 months (range 6 to 13)
• based on an exit questionnaire a responder was defined as one who rated the interstitial cystitis symptoms as moderately improved or better.
• a 60% BCG response rate was noted, compared to a 27% placebo response rate
• minimum voided volume and quality of life improved in the BCG group compared to placebo; adverse events were similar in each group, mostly irritative in nature, and no significant systemic events were noted.
• the authors conclude that intravesical Tice strain BCG appears to be safe and efficacious in the treatment of interstitial cystitis but that additional studies must be performed to confirm the results of this pilot study
Intravesical glycosaminoglycan replenishment with chondroitin sulphate in chronic forms of cystitis. A multi-national, multi-centre, prospective observational clinical trial. Nordling J, van Ophoven A. Arzneimittelforschung 2008;58:328-35 .(PMID:18751498)
- effectiveness, safety nd tolerability of instillation therapy with chondroitin sulphate was investigated in 286 patients with chronic forms of cystitis including radiation cystitis, overactive bladder, chronically recurring cystitis and IC.
- the instillation was effective and well tolerated in the treatment of chronic forms of cystitis associated with a possible GAG layer deficit, but the results need to be confirmed in a controlled study.
A real-life multicentre clinical practice study to evaluate the efficacy and safety of intravesical chondroitin sulphate for the treatment of interstitial cystitis. Nickel JC, Egerdie B, Downey J, et al. BJU Int 2008 Sep 3. [Epub ahead of print] • a multicentre, community based open-label study designed to assess the efficacy and safety of intravesical sodium chondroitin sulphate in the treatment of patients with the clinical diagnosis of interstitial cystitis (IC)
• patients with IC were treated with sodium chondroitin sulphate (Uracyst®) solution 2.0% via urinary catheter weekly for 6 weeks and then monthly for 16 weeks for a total of 10 treatments
• the primary endpoint was the percentage of responders to treatment as indicated by a marked or moderate improvement on a seven-point patient Global Response Assessment (GRA) scale at week 10 (4 weeks after the initial six treatments) compared with baseline; a secondary efficacy endpoint (durability) was the percentage of responders on the GRA scale after 10 treatments.
• 47% of the 53 enrolled patients with long standing moderately severe IC were responders at week 10; at 24 weeks, 60% were responders
Hyaluronan treatment of interstitial cystitis/painful bladder syndrome. Riedl CR, Engelhardt PF, Daha KL, et al. Int Urogynecol J Pelvic Floor Dysfunct 2007 Dec 21 [Epub ahead of print] • this study evaluated the efficacy of intravesical hyaluronan therapy in 126 patients with IC/PBS and mean disease duration of 6.1 years; to be eligible for hyaluronan treatment, a positive modified potassium test was requested as a sign of a urine-tissue barrier disorder • patients were treated with weekly instillations of a 50 ml phosphate-buffered saline solution containing 40 mg sodium hyaluronate
• data were obtained by a visual analogue scale (VAS) questionnaire rating from 0 to 10 that asked for global bladder symptoms before and after therapy; additional questions evaluated the therapeutic impact on quality of life.
• 85% of the patients reported symptom improvement (2 or more VAS units); the mean initial VAS score of 8.5 decreased to 3.5 after therapy (p<0.0001); 55% remained with no or minimal bladder symptoms after therapy (VAS 0-2); 84% reported significant improvement of their quality of life
• intravesical therapy had to be initiated again with good success in 43 patients (34.5%) as symptoms recurred after discontinuation of treatment, while the rest stayed free of symptoms for up to 5 years
• in general, hyaluronan therapy was well tolerated and, with the exception of mild irritative symptoms, no adverse reactions were reported for a total of 1,521 instillations
• the authors conclude that timely hyaluronan instillation therapy may lead to complete symptom remission or even cure in part of the IC/PBS patients, while some responders need continuous intravesical therapy
• the present results suggest that selection of patients for hyaluronan therapy by potassium testing improves the outcome of intravesical therapy with a response rate of >80%
[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
Pharmacologic management of painful bladder syndrome/interstitial cystitis: a systematic review. Dimitrakov J, Kroenke K, Steer WD, et al. Arch Intern Med 2007;167:1922-9. • over 180 different therapies have been tried for PBS/IC, yet evidence from trials remains inconclusive
• this study concludes that PPS may be modestly beneficial for PBS/IC
• there is insufficient evidence for other pharmacologic treatment
• a consensus on standardized outcome measures is urgently needed
New frontiers in intravesical therapies and drug delivery. Giannatoni A, Di Stasi SM, Chancellor MB, et al. Eur Urol 2006:50:1183-93
• Electromotive drug administration (EMDA), new in situ delivery systems and bioadhesive liposomes may make it possible to extend intravesical therapy and drug administration to many bladder diseases. Further research is needed to make this a reality (review)
Efficacy of interstitial cystitis treatments: a review. Karsenty G, AlTaweel W, Hajebrahimi S, Corcos J. EAU-EBU Update Series 2006;4:47-61
• in this article, the degree of evidence regarding the clinical efficacy of available interstitial cystitis treatment options is reviewed
• only three therapies are supported by a high level of evidence: oral cimetidine and amitriptyline and the intravesical dimethylsulfoxide (DMSO)
not yet sorted
Critical appraisal of dimethyl sulfoxide treatment for interstitial cystitis: discomfort, side-effects and treatment outcome. Rössberger J, Fall M, Peeker R.
Scand J Urol Nephrol 2005;39:73-7
Treatment of interstitial cystitis with Cystistat: a hyaluronic acid product. Kallstrup EB, Jorgensen SS, Nordling J, Half T.
Scand J Urol Nephrol 2005;39:143-7
Enhanced binding of modified pentosan polysulfate and heparin to bladder: a strategy for improved treatment of interstitial cystitis. Muthusamy A, Erickson DR, Sheykhnazari M, Bhavanandan VP.
Effect of intravesical resiniferatoxin (RTX) on lower urinary tract symptoms, urodynamic parameters, and quality of life of patients with urodynamic increased bladder sensation. Apostolidis A, Gonzales GE, Fowler CJ.
Eur Urol 2006 May 4; [Epub ahead of print]
Successful downregulation of bladder sensory nerves with combination of heparin and alkalinized lidocaine in patients with interstitial cystitis. Parsons CL. Urology 2005;65:45-8
Absorption of alkalized intravesical lidocaine in normal and inflamed bladders: a simple method for improving bladder anesthesia. Henry R, Patterson L, Avery N, et al. J Urol 2001;165(6 Pt 1):1900-3