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Efficacy of Clorpactin in refractory bladder pain syndrome/interstitial cystitis: a randomized controlled trial

A Commentary to this article was published on 11 March 2021

Abstract

Introduction

Clorpactin is an antibacterial agent with limited evidence for its use as instillation therapy in patients with bladder pain syndrome/interstitial cystitis (BPS/IC).

This was a multi-centre, single-blinded randomized controlled trial to investigate whether Clorpactin instillation results in symptom improvement in patients with refractory BPS/IC.

Methods

Fifty women with refractory BPS/IC were randomized to undergo cystoscopy/hydrodistension (25) or instillation of Clorpactin 0.4% solution (25) under general anaesthesia. Primary outcome was based on Global Response Assessment (GRA) at 3 months; secondary outcomes were based on O’Leary Sant Symptom (OLSI) and Problem (OLPI) questionnaire scores, visual analogue scale (VAS) score for pain and bladder diary parameters.

Results

Complete follow-up data were available on 22 in the hydrodistension group and 16 in the Clorpactin group. GRA improvement was 4.5% for hydrodistension and 56% for Clorpactin (p = 0.001) at 3 months. Reduction in mean total scores for OLSI (14.1 to 9.1; p = 0.004) and OLPI (12.6 to 7.4; p = 0.001) was seen in the Clorpactin group only. VAS pain scores were reduced in the Clorpactin group only (7.4 to 3.3; p < 0.001). Post-treatment VAS pain scores did not differ between groups although 6/25 (24%) women in the Clorpactin group required admission for pain compared to 1/25 (4%) in the hydrodistension group.

Conclusions

Clorpactin treatment results in significant improvement in BPS/IC symptoms, bother and pain based on the GRA, OLSI/OLPI and VAS pain scores at 3 months post-treatment compared to cystoscopy/hydrodistension. These conclusions are limited by the high loss to follow-up in both groups.

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Correspondence to Kristina Cvach.

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Presented as an oral poster at the International Urogynecological Association Annual Scientific Meeting; Vienna, Austria; June 2018

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Cvach, K., Rosamilia, A., Dwyer, P. et al. Efficacy of Clorpactin in refractory bladder pain syndrome/interstitial cystitis: a randomized controlled trial. Int Urogynecol J 32, 1177–1183 (2021). https://doi.org/10.1007/s00192-020-04652-3

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  • DOI: https://doi.org/10.1007/s00192-020-04652-3

Keywords

  • Bladder pain syndrome
  • Interstitial cystitis
  • Instillation
  • Clorpactin
  • Hydrodistension