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Treatment of bladder pain syndrome and interstitial cystitis: a systematic review

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Abstract

Introduction and hypothesis

Bladder pain syndrome/interstitial cystitis (BPS/IC) has various treatments; however, no standardized treatment has been established. The aim was to analyze different types of treatment of BPS/IC and their effectiveness.

Methods

A literature review with a search strategy for articles related to BPS/IC published between 1990 and 2014 was conducted on MEDLINE, PUBMED, and SCOPUS. Only randomized controlled trials in women were included in the meta-analysis, while other experimental studies were used as bases for a systematic review of the topic. Clinical trial quality was defined according to the Jadad scale.

Results

Of 356 articles, 13 were included in the analysis. The intervention methods were as follows: instillation of hyaluronic acid, botulinum toxin A, intravesical lidocaine, hyperbaric chamber, massage, physiotherapy, phosphate-buffered saline, piroxicam in combination with doxepin, and others. We did not find any treatment with at least two randomized controlled trials for meta-analysis. Among the assessment tools for symptoms of BPS/IC, the most frequently used were the visual analogue scale, voiding record, and the O’Leary–Sant questionnaire.

Conclusion

Existing studies were not able to define the best approach for the treatment of BPS/IC. The lack of standardized treatment may be related to the diversity of interventions used; therefore, further studies with better methodological quality are needed.

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References

  1. Campbell F, Collett BJ (1994) Chronic pelvic pain. Br J Anaesth 73:571–573. doi:10.1093/bja/73.5.571

    Article  CAS  PubMed  Google Scholar 

  2. Grace V, Zondervan K (2006) Chronic pelvic pain in women in New Zealand: comparative well-being, comorbidity, and impact on work and other activities. Health Care Women Int 27:585–599. doi:10.1080/07399330600803725

    Article  PubMed  Google Scholar 

  3. Howard FM (2003) Chronic pelvic pain. Obstet Gynecol 101:594–611. doi:10.1016/S0029-7844(02)02723-0

    PubMed  Google Scholar 

  4. Hanno P, Dmochiwisk R (2009) Status of international consensus on interstitial cystitis/bladder pain syndrome/painful bladder syndrome: 2008 snapshot. Neurol Urodyn 28:274–286. doi:10.1002/nau.20687

    Article  Google Scholar 

  5. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, van Kerrebroeck P, Wein A (2002) The standardization of terminology of lower urinary tract function: report from the standardization subcommittee of the International Continence Society. Neurourol Urodyn 187:116–126. doi:10.1067/mob.2002.125704

    Google Scholar 

  6. Coelho MF, Rebola J (2003) Cistite Intersticial: etiopatogenia e atitudes terapêuticas. Acta Urol Lisboa 20:19–24

    Google Scholar 

  7. Berry SH, Elliott MN, Suttorp M, Bogart LM, Stoto MA, Eggers P, Nyberg L, Clemens JQ (2011) Prevalence of symptoms of bladder pain syndrome/interstitial cystitis among adult females in the United States. J Urol 186:540–544. doi:10.1016/j.juro.2011.03.132

    Article  PubMed  PubMed Central  Google Scholar 

  8. Yoost JL, Hertweck SP, Loveless M (2012) Diagnosis and treatment of interstitial cystitis in adolescents. J Pediatr Adolesc Gynecol 25:162–171. doi:10.1016/j.jpag.2011.03.011

    Article  CAS  PubMed  Google Scholar 

  9. Theoharides C (2007) Treatment approaches for painful bladder syndrome/interstitial cystitis. Drugs 67:215–235. doi:10.2165/00003495-200767020-00004

    Article  CAS  PubMed  Google Scholar 

  10. Forrest JB, Moldwin R (2008) Diagnostic options for early identification and management of interstitial cystitis/painful bladder syndrome. Int J Clin Pract 62:1926–1934. doi:10.1111/j.1742-1241.2008.01931.x

    Article  CAS  PubMed  Google Scholar 

  11. Hanno P, Nordling J, van Ophoven A (2008) What is new in bladder pain syndrome/interstitial cystitis? Curr Opin Urol 18:353–358. doi:10.1097/MOU.0b013e3282fcea88

    Article  PubMed  Google Scholar 

  12. Seth A, Teichman JMH (2008) What's new in the diagnosis and management of painful bladder syndrome/interstitial cystitis? Curr Urol Rep 9:349–357. doi:10.1007/s11934-008-0061-9

    Article  PubMed  Google Scholar 

  13. Tirumuru S, Al-Kurdi D, Latthe P (2010) Intravesical botulinum toxin A injections in the treatment of painful bladder syndrome/interstitial cystitis: a systematic review. Int Urogynecol J 21:1285–1300. doi:10.1007/s00192-010-1162-9

    Article  PubMed  Google Scholar 

  14. Matsuoka PK, Haddad JM, Pacetta AM, Baracat EC (2012) Intravesical treatment of painful bladder syndrome: a systematic review and meta-analysis. Int Urogynecol J 23:1147–1153. doi:10.1007/s00192-012-1686-2

    Article  CAS  PubMed  Google Scholar 

  15. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12. doi:10.1016/0197-2456(95)00134-4

    Article  CAS  PubMed  Google Scholar 

  16. Barbalias GA, Liatsikos EN, Athanasopoulos A, Nikiforids G (2000) Interstitial cystitis: bladder training with intravesical oxybutynin. J Urol 163:1818–1822. doi:10.1016/S0022-5347(05)67551-9

    Article  CAS  PubMed  Google Scholar 

  17. O’Reilly BA, Dwyer PL, Hawthorne G, Cleaver S, Thomas E, Rosamilia A, Fynes M (2004) Transdermal posterior tibial nerve laser therapy is not effective in women with interstitial cystitis. J Urol 172:1880–1883. doi:10.1097/01.ju.0000142846.47245.16

    Article  PubMed  Google Scholar 

  18. Smith CP, Chancellor MB (2004) Emerging role of botulinum toxin in the management of voiding dysfunction. J Urol 171:2128–2137. doi:10.1097/01.ju.0000127725.48479.89

    Article  CAS  PubMed  Google Scholar 

  19. Messing EM, Walsh PC, Retik AB, Stamey TA, Vaughan ED (1992) Campbell’s urology. In: Jr (eds) Interstitial cystitis and related syndromes, 6th edn. Philadelphia, pp 982–1005

  20. Hanno PM, Wein AJ (1994) Interstitial cystitis, part II. Urol Clin 21:136–141

    Google Scholar 

  21. Porru D, Leva F, Parmigiani A, Barletta D, Gardella B, Dacco MD, Nappi RE, Allegri M, Tinelli C, Bianchi CM, Spinillo A, Rovereto B (2012) Impact of intravesical hyaluronic acid and chondroitin sulfate on bladder pain syndrome/interstitial cystitis. Int Urogynecol J 23:1193–1199. doi:10.1007/s00192-011-1546-5

    Article  PubMed  Google Scholar 

  22. Parsons CL, Lilly JD, Stein P (1991) Epithelial dysfunction in nonbacterial cystitis (interstitial cystitis). J Urol 145:732–735

    CAS  PubMed  Google Scholar 

  23. Daha LK, Riedl CR, Lazar D, Hohlbrugger G, Pflüger H (2005) Do cystometric findings predict the results of intravesical hyaluronic acid in women with interstitial cystitis? Eur Urol 47:393–397. doi:10.1016/j.eururo.2004.10.022

    Article  PubMed  Google Scholar 

  24. Nickel JC, Hanno P, Kumar K, Thomas H (2012) Second multicenter, randomized, double-blind, parallel-group evaluation of effectiveness and safety of Intravesical sodium chondroitin sulfate compared with inactive vehicle control in subjects with interstitial cystitis/bladder pain syndrome. Urology 79:1220–1224. doi:10.1016/j.urology.2012.01.059

    Article  PubMed  Google Scholar 

  25. Shao Y, Shen ZJ, Rui WB, Zhou WL (2010) Intravesical instillation of hyaluronic acid prolonged the effect of bladder hydrodistention in patients with severe interstitial cystitis. J Urol 75:547–550. doi:10.1016/j.urology.2009.09.078

    Article  Google Scholar 

  26. Lv YS, Zhou HL, Mao HP, Gao R, Wang YD, Xue XY (2012) Intravesical hyaluronic acid and alkalinized lidocaine for the treatment of severe painful bladder syndrome/interstitial cystitis. Int Urogynecol J 23:1715–1720. doi:10.1007/s00192-012-1802-3

    Article  PubMed  Google Scholar 

  27. Anderson VR, Perry CM (2006) Pentosan polysulfate: a review of its use in the relief of bladder pain or discomfort in interstitial cystitis. Drugs 4:18–23

    Google Scholar 

  28. Mulholland SG, Hanno P, Parsons CL, Sant GR, Staskin DR (1990) Pentosan polysulfate sodium for therapy of interstitial cystitis: a double-blind placebo-controlled clinical study. Urology 35:552–558

    Article  CAS  PubMed  Google Scholar 

  29. La Rock DR, Sant GR (1997) Intravesical therapies for interstitial cystitis. In: Sant GR (ed) Interstitial cystitis. Lippincott-Raven, Philadelphia

    Google Scholar 

  30. 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 79:168–171. doi:10.1046/j.1464-410X.1997.03384.x

    Article  CAS  PubMed  Google Scholar 

  31. Davis EL, El Khoudary SR, Talbott EO, Davis J, Regan LJ (2008) Safety and efficacy of the use of intravesical and oral pentosan polysulfate sodium for interstitial cystitis: a randomized double-blind clinical trial. J Urol 179:177–185. doi:10.1016/j.juro.2007.08.170

    Article  CAS  PubMed  Google Scholar 

  32. Zeidman EJ, Helfrick B, Pollard C, Thompson IM (1994) Bacillus Calmette-Guérin immunotherapy for refractory interstitial cystitis. Urology 43:121–124. doi:10.1016/S0090-4295(94)80284-X

    Article  CAS  PubMed  Google Scholar 

  33. Peters K, Diokno A, Steinert B, Yuhico M, Mitchell B, Krohta S, Gillette B, Gonzalez J (1997) The efficacy of intravesical tice strain bacillus Calmette-Guérin in the treatment of interstitial cystitis: a double-blind, prospective, placebo controlled trial. J Urol 157:2090–2094. doi:10.1016/S0022-5347(01)64682-2

    Article  CAS  PubMed  Google Scholar 

  34. Buyse G, Waldeck K, Verpoorten C, Björk H, Casaer P, Andersson KE, Buyse G, Waldeck K, Verpoorten C, Björk H, Casaer P, Andersson KE (1998) Intravesical oxybutynin for neurogenic bladder dysfunction: less systemic side effects due to reduced first pass metabolism. J Urol 160:811–823. doi:10.1016/S0022-5347(01)62828-3

    Article  Google Scholar 

  35. Simunovic Z, Trobonjaca T, Trobonjaca Z (1998) Treatment of medial and lateral epicondylitis-tennis and golfer’s elbow-with low level laser therapy: a multicenter double blind, placebo-controlled clinical study on 324 patients. J Clin Laser Med Surg 16:145–151

    CAS  PubMed  Google Scholar 

  36. Apostolidis A, Popat R, Yiangou Y, Cockayne D, Ford AP, Davis JB, Dasgupta P, Fowler CJ, Anand P (2005) Decreased sensory receptors P2X3 and TRPV1 in suburothelial nerve fibers following intradetrusor injections of botulinum toxin for human detrusor overactivity. J Urol 174:977–983. doi:10.1097/01.ju.0000169481.42259.54

    Article  CAS  PubMed  Google Scholar 

  37. Kuo HC (2005) Clinical effects of suburothelial injection of botulinum A toxin on patients with non-neurogenic detrusor overactivity refractory to anticholinergics. Urology 66:94–98. doi:10.1016/j.urology.2005.02.002

    Article  PubMed  Google Scholar 

  38. Manning J, Dwyer P, Rosamilia A, Colyvas K, Murray C, Fitzgerald E (2013) A multicentre, prospective, randomised, double-blind study to measure the treatment effectiveness of abobotulinum A (AboBTXA) among women with refractory interstitial cystitis/bladder pain syndrome. Int Urogynecol J 25:593–595. doi:10.1007/s00192-013-2267-8

    Article  PubMed  Google Scholar 

  39. Neheman A, Nativ O, Moskovitz B, Melamed Y, Stein A (2005) Hyperbaric oxygen therapy for radiation-induced haemorrhagic cystitis. BJU 96:107–109. doi:10.1111/j.1464-410X.2005.05577.x

    Article  Google Scholar 

  40. Rosamilia A, Cann L, Dwyer P, Scurry J, Rogers P (1999) Bladder microvasculature in women with interstitial cystitis. J Urol 161:1865–1870. doi:10.1016/S0022-5347(05)68830-1

    Article  CAS  PubMed  Google Scholar 

  41. Irwin P, Galloway NT (1993) Impaired bladder perfusion in interstitial cystitis: a study of blood supply using laser Doppler flowmetry. J Urol 149:890–892

    CAS  PubMed  Google Scholar 

  42. Pontari MA, Hanno PM, Ruggieri MR (1999) Comparison of bladder blood flow in patients with and without interstitial cystitis. J Urol 86:711–715. doi:10.1016/S0022-5347(05)68552-7

    Google Scholar 

  43. Van Ophoven A, Rossbach G, Pajonk F, Hertle L (2006) Safety and efficacy of hyperbaric oxygen therapy for the treatment of interstitial cystitis: a randomized, sham-controlled, double-blind trial. J Urol 175:1442–1446. doi:10.1016/j.juro.2006.06.065

    Article  Google Scholar 

  44. Mannocci JF (1995) Disfunções sexuais: abordagem clínica e terapêutica, 3rd edn. Fundo Editorial BYK, São Paulo

    Google Scholar 

  45. FitzGerald MP, Anderson RU, Potts J, Payne CK, Peters KM, Clemens JQ, Kotarinos R, Fraser L, Cosby A, Fortman C, Neville C, Badillo S, Odabachian L, Sanfield A, O’Dougherty B, Halle-Podell R, Cen L, Chuai S, Landis JR, Mickelberg K, Barrell T, Kusek JW, Nyberg LM (2009) Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. J Urol 182:570–580. doi:10.1016/j.juro.2009.04.022

    Article  PubMed  PubMed Central  Google Scholar 

  46. Simons DG, Travell JG, Simons LS (1998) Myofascial pain and dysfunction: the trigger point manual, 2nd edn. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  47. FitzGerald MP, Payne CK, Lukacz ES, Yang CC, Peters KM, Chai TC, Nickel JC, Hanno PM, Kreder KJ, Burks DA, Mayer R, Kotarinos R, Fortman C, Allen TM, Fraser L, Mason-Cover M, Furey C, Odabachian L, Sanfield A, Chu J, Huestis K, Tata GE, Dugan N, Sheth H, Bewyer K, Anaeme A, Newton K, Featherstone W, Halle-Podell R, Cen L, Landis JR, Propert KJ, Foster HE Jr, Kusek JW, Nyberg LM (2012) Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome and pelvic floor tenderness. J Urol 182:2113–2118. doi:10.1016/j.juro.2012.01.123

    Article  Google Scholar 

  48. Russo J Jr, Lipman AG, Comstock TJ, Page BC, Stephen RL (1980) Lidocaine anaesthesia: comparison of iontophoresis, injection and swabbing. Am J Hosp Pharm 22:152–155

    Google Scholar 

  49. Hicks RM, Ketterer B, Warren RC (1974) The ultrastructure and chemistry of the luminal plasma membrane of the mammalian urinary bladder: a structure with low permeability to water and ions. Philos Trans R Soc Lond B Biol Sci 268:23–38

    Article  CAS  PubMed  Google Scholar 

  50. Rosamilia A, Dwyer PL, Gibson J (1997) Electromotive drug administration of lidocaine and dexamethasone followed by cystodistension in women with interstitial cystitis. Int Urogynecol J Pelvic Floor Dysfunct 8:142–145

    Article  CAS  PubMed  Google Scholar 

  51. Porru D, Campus G, Tudino D, Valdes E, Vespa A, Scarpa RM, Usai E (1997) Results of treatment of refractory interstitial cystitis with intravesical hyaluronic acid. Urol Int 59:26–29. doi:10.1159/000283012

    Article  CAS  PubMed  Google Scholar 

  52. Cervigni M, Natale F, Nasta L, Padoa A, Voi RL, Porru D (2008) A combined intravesical therapy with hyaluronic acidand chondroitin for refractory painful bladder syndrome/interstitial cystitis. Int Urogynecol J 19:943–247. doi:10.1007/s00192-008-0572-4

    Article  CAS  Google Scholar 

  53. Giberti C, Gallo F, Cortese P, Schenone M (2013) Combined intravesical sodium hyaluronate/chondroitin sulfate therapy for interstitial cystitis/bladder pain syndrome: a prospective study. Ther Adv Urol 5:175–179. doi:10.1177/1756287213490052

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Daha LK, Lazar D, Simak R, Pflüger H (2007) Is there a relation between urinary interleukin-6 levels and symptoms before and after intra-vesical glycosaminoglycan substitution therapy in patients with bladder pain syndrome/interstitial cystitis? Int Urogynecol J 18:1449–1452. doi:10.1007/s00192-007-0354-4

    Article  Google Scholar 

  55. Aghamir SM, Mohseni MG, Arasteh S (2007) Intravesical bacillus Calmette-Guérin for treatment of refractory interstitial cystitis. J Urol 4:18–23

    Google Scholar 

  56. Magni G (1991) The use of antidepressants in the treatment of chronic pain. Drugs 42:730–748. doi:10.2165/00003495-199142050-00002

    Article  CAS  PubMed  Google Scholar 

  57. Weselmann U (2001) Interstitial cystitis: a chronic visceral pain syndrome. Urology 57:32–39. doi:10.1016/S0090-4295(01)01123-2

    Article  Google Scholar 

  58. Wammack R, Remzi M, Seitz C, Djavan B, Marberger M (2002) Efficacy of oral doxepin and piroxicam treatment for interstitial cystitis. Eur Urol 41:596–600. doi:10.1016/S0302-2838(02)00174-4

    Article  CAS  PubMed  Google Scholar 

  59. Shie JH, Liu HT, Wang YS, Kuo HC (2013) Immunohistochemical evidence suggests repeated intravesical application of botulinum toxin A injections may improve treatment efficacy of interstitial cystitis/bladder pain syndrome. BJU Int 111:638–646. doi:10.1111/j.1464-410X.2012.11466.x

    Article  CAS  PubMed  Google Scholar 

  60. Lee CL, Kuo HC (2013) Intravesical botulinum toxin A injections do not benefit patients with ulcer type interstitial cystitis. Pain Physician 16:109–116

    PubMed  Google Scholar 

  61. Mandel SA, Amit T, Kalfon L, Reznichenko L, Weinreb O, Youdim MB (2008) Cell signaling pathways and iron chelation in the neurorestorative activity of green tea polyphenols: special reference to epigallocatechin gallate (EGCG). J Alzheimers Dis 15:211–222

    CAS  PubMed  Google Scholar 

  62. Sant GR, Theoharides TC (1994) The role of the mast cell ininterstitial cystitis. Urol Clin North Am 21:41–53

    CAS  PubMed  Google Scholar 

  63. Liu M, Xu YF, Feng Y, Yang FQ, Luo J, Zhai W, Che JP, Wang GC, Zheng JH (2013) Epigallocatechin gallate attenuates interstitial cystitis in human bladder urothelium cells by modulating purinergic receptors. J Surg Res 183:397–404. doi:10.1016/j.jss.2012.11.041

    Article  CAS  PubMed  Google Scholar 

  64. Abehsira-Amar O, Gibert M, Joliy M, Thèze J, Jankovic DL (1992) IL-4 plays a dominant role in the differential development of TH0 into TH1 and TH2 cells. J Immunol 148:3820–3829

    CAS  PubMed  Google Scholar 

  65. Tsukagoshi H, Nagashima M, Horie T, Oyama T, Yoshii A, Sato T, Iizuka K, Dobashi K, Mori M (1998) Kimura’s disease associated with bronchial asthma presenting eosinophilia and hyperimmunoglobulinemia E which were attenuated by suplatast tosilate (IPD-1151T). Intern Med 37:1064–1067. doi:10.2169/internalmedicine.37.1064

    Article  CAS  PubMed  Google Scholar 

  66. Ueda T, Tamaki M, Ogawa O, Yamauchi T, Yoshimura N (2000) Improvement of interstitial cystitis symptoms and problems that developed during treatment with oral Ipd-1151t. J Urol 164:1917–1920. doi:10.1016/S0022-5347(05)66917-0

    Article  CAS  PubMed  Google Scholar 

  67. Thon WF, Baskin LS, Jonas U, Tanagho EA, Schimidt RA (1991) Neuromodulation of voiding dysfunction and pelvic pain. World J Urol 9:138–141. doi:10.1007/BF00202508

    Google Scholar 

  68. Bosch JL, Groen J (1995) Sacral (S3) segmental nerve stimulation as a treatment for urge incontinence in patients with detrusor instability: results of chronic electrical stimulation using an implantable neural prosthesis. Clin Urol 154:504–507. doi:10.1016/S0022-5347(01)67086-1

    CAS  Google Scholar 

  69. Maher CF, Carey MP, Dwyer PL, Schluter PL (2001) Percutaneous sacral nerve root neuromodulation for intractable interstitial cystitis. J Urol 165:884–886. doi:10.1016/S0022-5347(05)66551-2

    Article  CAS  PubMed  Google Scholar 

  70. Weiss JM (2001) Pelvic floor myofascial trigger points: manual therapy for interstitial cystitis and the urgency-frequency syndrome. J Urol 166:2226–2231. doi:10.1016/S0022-5347(05)65539-5

    Article  CAS  PubMed  Google Scholar 

  71. Oyama IA, Rejba A, Lukban JC, Fletcher E, Kellogg-Spadt S, Holzberg AS, Whitmore KE (2004) Modified Thiele massage as therapeutic intervention for female patients with interstitial cystitis and high-tone pelvic floor dysfunction. Urology 6:862–865. doi:10.1016/j.urology.2004.06.065

    Article  Google Scholar 

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Acknowledgements

The authors acknowledge the collaboration in the final review of the manuscript of Prof Dr Luiz Gustavo de Oliveira Britto, Prof Dr Antonio Alberto Nogueira, and Prof Dr Francisco José Candido dos Reis.

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We declare that this paper has no financial support and the authors have no conflict of interest with any public or private company.

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Correspondence to Julio Cesar Rosa-e-Silva.

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Pazin, C., de Souza Mitidieri, A.M., Silva, A.P.M. et al. Treatment of bladder pain syndrome and interstitial cystitis: a systematic review. Int Urogynecol J 27, 697–708 (2016). https://doi.org/10.1007/s00192-015-2815-5

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