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Which bladder instillations are more effective? DMSO vs. bupivacaine/heparin/triamcinolone: a retrospective study

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Abstract

Introduction and hypothesis

Bladder pain syndrome/interstitial cystitis (BPS/IC) is a chronic and debilitating condition. Our objective was to compare two different bladder instillation treatments in patients with BPS/IC: dimethyl sulfoxide with triamcinolone (DMSO) vs. bupivacaine with heparin and triamcinolone (B/H/T). Our hypothesis was that both treatments are equally effective.

Methods

A retrospective cohort study of instillation-naïve patients was conducted comparing responses to either DMSO or B/H/T at our tertiary urogynecology center from 2012 to 2014. The primary outcome was patient-reported percent of overall improvement from baseline. Secondary outcomes were change in patient-reported daytime voiding frequency (hours) and change in number of nighttime voiding episodes. Variables analyzed as potential confounders included pelvic pain, cystoscopy findings, levator spasm, and fibromyalgia. The two-sided Student’s t test, chi-squared test, Poisson regression, and repeated-measure analysis of variance (ANOVA) were used for analyses.

Results

One hundred and ninety-three eligible patients were identified (45 receiving DMSO, 146 receiving B/H/T). Compared with baseline, DMSO patients reported 63% improvement (p < 0.0001), increased time between daytime voids by 1.5 h (p < 0.00), and a 40% reduction in nocturia episodes (p < 0.00). B/H/T patients reported 51% improvement (p < 0.00), increased time between daytime voids by 1.4 h (p < 0.00), and an 8% reduction in nocturia episodes (p = 0.26). When comparing the two treatments, DMSO resulted in a greater percentage of overall improvement (p = 0.02) and a significant decrease in nocturia episodes when compared with B/H/T (p = 0.02). There was no significant difference between treatments for daytime voiding frequency (p = 0.50).

Conclusion

Bladder instillations with DMSO or B/H/T provide overall symptomatic improvement and improved frequency and nocturia. DMSO appears to provide greater improvement in nocturia and overall.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Division of Urogynecology, North Shore University Health System, 9650 Gross Point Road., Suite 3900, Skokie, IL, 60076, USA

    Shilpa Iyer, Elizabeth Lotsof, Ying Zhou, Alexis Tran, Carolyn Botros, Peter Sand, Roger Goldberg, Janet Tomezsko, Adam Gafni-Kane & Sylvia Botros

Authors
  1. Shilpa Iyer
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  2. Elizabeth Lotsof
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  3. Ying Zhou
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  4. Alexis Tran
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  5. Carolyn Botros
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  6. Peter Sand
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  7. Roger Goldberg
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  8. Janet Tomezsko
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  9. Adam Gafni-Kane
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  10. Sylvia Botros
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Corresponding author

Correspondence to Shilpa Iyer.

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No outside funding was received.

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Iyer, S., Lotsof, E., Zhou, Y. et al. Which bladder instillations are more effective? DMSO vs. bupivacaine/heparin/triamcinolone: a retrospective study. Int Urogynecol J 28, 1335–1340 (2017). https://doi.org/10.1007/s00192-017-3266-y

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  • DOI: https://doi.org/10.1007/s00192-017-3266-y

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