International Urogynecology Journal

, Volume 23, Issue 9, pp 1147–1153 | Cite as

Intravesical treatment of painful bladder syndrome: a systematic review and meta-analysis

  • P. K. Matsuoka
  • J. M. Haddad
  • A. M. Pacetta
  • E. C. Baracat
Review Article


Introduction and hypothesis

The objective of the study was to assess the effectiveness of intravesical treatment for painful bladder syndrome (PBS).


A systematic review was performed until December 31, 2010. The selection criteria included only randomized controlled trials of PBS patients who received intravesical treatment. The primary outcomes measures were clinical and urodynamic parameters. Relative risk and mean differences were used for binary and continuous outcomes respectively, with confidence interval of 95%.


The search strategy identified 770; however, only 28 eligible trials met methodological requirements for complete analysis. Altogether, the review included four treatment modalities: resiniferatoxin, Bacillus Calmette–Guérin (BCG), oxybutynin, and alkalinized lidocaine. Meta-analysis of BCG therapy showed improvement in symptoms according to the Wisconsin Interstitial Cystitis Symptom Inventory, but no difference in 24-h urinary frequency.


Meta-analysis showed an improvement exclusively of the symptoms as measured by the Wisconsin Interstitial Cystitis Inventory, but not in 24-h urinary frequency, with BCG therapy. Further randomized clinical trials, including trials of more recent drugs, are required for evaluation of intravesical therapies for PBS.


Painful bladder syndrome Interstitial cystitis Intravesical administration Treatment 



The authors would like to thank Wanderley Marques Bernardo for his contribution to the statistic analysis portion of the study.

Conflicts of interest



  1. 1.
    Nickel JC (2004) Interstitial cystitis: a chronic pelvic pain syndrome. Med Clin North Am 88:467–481, xiiPubMedCrossRefGoogle Scholar
  2. 2.
    Bade JJ, Laseur M, Nieuwenburg A, van der Weele LT, Mensink HJ (1997) A placebo-controlled study of intravesical pentosanpolysulphate for the treatment of interstitial cystitis. Br J Urol 79:168–171PubMedCrossRefGoogle Scholar
  3. 3.
    Barbalias GA, Liatsikos EN, Athanasopoulos A, Nikiforidis G (2000) Interstitial cystitis: bladder training with intravesical oxybutynin. J Urol 163:1818–1822PubMedCrossRefGoogle Scholar
  4. 4.
    Andersson KE (2002) Treatment of the overactive bladder: possible central nervous system drug targets. Urology 59:18–24PubMedCrossRefGoogle Scholar
  5. 5.
    Jasmin L, Janni G, Manz HJ, Rabkin SD (1998) Activation of CNS circuits producing a neurogenic cystitis: evidence for centrally induced peripheral inflammation. J Neurosci 18:10016–10029PubMedGoogle Scholar
  6. 6.
    Marchand JE, Sant GR, Kream RM (1998) Increased expression of substance P receptor-encoding mRNA in bladder biopsies from patients with interstitial cystitis. Br J Urol 81:224–228PubMedCrossRefGoogle Scholar
  7. 7.
    Fowler CJ (2002) Bladder afferents and their role in the overactive bladder. Urology 59:37–42PubMedCrossRefGoogle Scholar
  8. 8.
    Wein AJ, Hanno PM (2002) Targets for therapy of the painful bladder. Urology 59:68–73PubMedCrossRefGoogle Scholar
  9. 9.
    Chen TY, Corcos J, Camel M, Ponsot Y, le Tu M (2005) Prospective, randomized, double-blind study of safety and tolerability of intravesical resiniferatoxin (RTX) in interstitial cystitis (IC). Int Urogynecol J Pelvic Floor Dysfunct 16:293–297PubMedCrossRefGoogle Scholar
  10. 10.
    Goldstein HB, Safaeian P, Garrod K, Finamore PS, Kellogg-Spadt S, Whitmore KE (2008) Depression, abuse and its relationship to interstitial cystitis. Int Urogynecol J Pelvic Floor Dysfunct 19:1683–1686PubMedCrossRefGoogle Scholar
  11. 11.
    Mayer R, Propert KJ, Peters KM et al (2005) A randomized controlled trial of intravesical Bacillus Calmette–Guerin for treatment refractory interstitial cystitis. J Urol 173:1186–1191PubMedCrossRefGoogle Scholar
  12. 12.
    Hanno PM, Landis JR, Matthews-Cook Y, Kusek J, Nyberg L Jr (1999) The diagnosis of interstitial cystitis revisited: lessons learned from the National Institutes of Health Interstitial Cystitis Database study. J Urol 161:553–557PubMedCrossRefGoogle Scholar
  13. 13.
    Gillenwater JY, Wein AJ (1988) Summary of the National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases Workshop on Interstitial Cystitis, National Institutes of Health, Bethesda, Maryland, August 28–29, 1987. J Urol 140:203–206PubMedGoogle Scholar
  14. 14.
    Kuo HC, Chancellor MB (2009) Comparison of intravesical botulinum toxin type A injections plus hydrodistention with hydrodistention alone for the treatment of refractory interstitial cystitis/painful bladder syndrome. BJU Int 104:657–661PubMedCrossRefGoogle Scholar
  15. 15.
    Locali RF, Buffolo E, Palma JH (2006) Use of aprotinin in thoracic aortic operations associated with deep hypothermic circulatory arrest: a meta-analysis. Rev Bras Cir Cardiovasc 21:377–385Google Scholar
  16. 16.
    Locali RF, Buffolo E, Catani R (2006) Radial artery versus saphenous vein to myocardial revascularization: meta-analysis (there is no statistically significant difference). Rev Bras Cir Cardiovasc 21:255–261CrossRefGoogle Scholar
  17. 17.
    Locali RF, Matsuoka PK, Cherbo T, Gabriel EA, Buffolo E (2010) Should biatrial heart transplantation still be performed?: a meta-analysis. Arq Bras Cardiol 94:829–840PubMedCrossRefGoogle Scholar
  18. 18.
    Hochman B, Locali RF, Matsuoka PK, Ferreira LM (2008) Intralesional triamcinolone acetonide for keloid treatment: a systematic review. Aesthetic Plast Surg 32:705–709PubMedCrossRefGoogle Scholar
  19. 19.
    Phillips B, Ball C, Sackett D et al (2009) Oxford Centre for evidence-based medicine—levels of evidence. Oxford: University of Oxford, CEBM. Available at:
  20. 20.
    Jadad AR, Moore RA, Carroll D et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12PubMedCrossRefGoogle Scholar
  21. 21.
    Nickel JC, Moldwin R, Lee S, Davis EL, Henry RA, Wyllie MG (2009) Intravesical alkalinized lidocaine (PSD597) offers sustained relief from symptoms of interstitial cystitis and painful bladder syndrome. BJU Int 103:910–918PubMedCrossRefGoogle Scholar
  22. 22.
    Payne CK, Mosbaugh PG, Forrest JB et al (2005) Intravesical resiniferatoxin for the treatment of interstitial cystitis: a randomized, double-blind, placebo controlled trial. J Urol 173:1590–1594PubMedCrossRefGoogle Scholar
  23. 23.
    Irani D, Heidari M, Khezri AA (2004) The efficacy and safety of intravesical Bacillus-Calmette–Guerin in the treatment of female patients with interstitial cystitis: a double-blinded prospective placebo controlled study. Urol J 1:90–93PubMedGoogle Scholar
  24. 24.
    Dawson TE, Jamison J (2007) Intravesical treatments for painful bladder syndrome/interstitial cystitis. Cochrane Database Syst Rev. doi: 10.1002/14651858.CD006113.pub2
  25. 25.
    Higgins J, Thompson S, Deeks J, Altman D (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560PubMedCrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2012

Authors and Affiliations

  • P. K. Matsuoka
    • 1
    • 2
  • J. M. Haddad
    • 1
  • A. M. Pacetta
    • 1
  • E. C. Baracat
    • 1
  1. 1.Urogynecology Division, Department of Gynecology and ObstetricsUSPSao PauloBrazil
  2. 2.São PauloBrazil

Personalised recommendations