Treatment Management In Interstitial Cystitis/Painful Bladder Syndrome

Abstract

Aim: Bladder pain syndrome is a chronic disease with unknown etiology and treatment of the disease has not been clearly defined. Any curative treatment choice does not exist for bladder pain syndrome. Various medical treatment choices have been introduced but treatment is usually performed specifically and empirically. Alternative treatment strategies and/or treaatment combinations may be selected. In our study, we aimed to evaluate the treatment strategies and success for bladder pain syndrome.Material and Methods: The medical records of 47 patients diagnosed with bladder pain syndrome between January 2008 and June 2015 have been investigated retrospectively. Patients who have been treated first at our clinic and who have received amitriptyline, pentosan polysulphate PPS , hydrodystension HD , intracavitary dimethylsulphoxyde DMSO and intracavitary botulinum toxin BTİ injection treatment together with supportive treatment have been included to the study. Twelve patients who have not completed follow-up course following treatment and 9 patients who have received treatment before have been excluded. Patient satisfaction and higher than 50% decrease in visual analog score VAS have been accepted as treatment success.Results: Mean age of 26 patients was 42,8±10,2 32-59 . Five of 26 patients who have received conservative treatment and amitriptyline treatment gained benefit from treatment. Twelve of 26 patients have not received PPS treatment and 14 patients have received PPS treatment. Of these 14 patients, 3 of them have improved. HD treatment has been proposed to 11 patients, 3 of 7 patients who have received HD treatment have improved. Two of 4 patients who have received intracavitary DMSO treatment have gained benefit from the treatment. Two of 4 patients who have received intracavitary BTI treatment have gained benefit from the treatment. Eleven of 26 patients have not improved following any of the treatment strategies.Conclusion: Bladder pain syndrome is a chronic disease with worse patient compliance. Low success rates of different tretmant stages worsens the patients’ compliance to the treatment. Patient and clinician awareness for absence of curative treatment modality and knowledge for the fact that some symptomatic improvements mean an already won victory might increase compliance to the treatment.

Keywords

• Interstitial cystitis,bladder pain syndrome,treatment

İnterstisyel Sistit/Ağrılı Mesane Sendromunda Tedavi Yönetimi

Abstract

Giriş: Ağrılı mesane sendromu nedeni bilinmeyen kronik bir hastalıktır ve tedavisi iyi tanımlanmış değildir. Ağrılı mesane sendromu için küratif tedavi seçeneği yoktur. Çeşitli ilaç tedavileri vardır, ancak tedavi genellikle özgün ve ampirik olarak uygulanmaktadır. Tedavi alternatifleri ve/veya tedavi kombinasyonu denemek gerekebilir. Çalışmamızda kliniğimizde uygulanan Ağrılı mesane sendromunun tedavi basamaklarını ve başarısını irdelemeyi amaçladık.Gereç ve Yöntemler: Ocak 2008-Haziran 2015 tarihleri arasında kliniğimizde İnterstisyel sistit/ağrılı mesane sendromu tanısı konulan 47 hastanın kayıtları retrospektif olarak incelendi. İlk tedavisi kliniğimizde başlanan, destekleyici tedaviye ek olarak Amitriptilin, Pentosan Polisülfat, Hidrodistansiyon, İntrakaviter Dimetilsülfoksit ve İntrakaviter botulinum toksin enjeksiyonu tedavisi uygulanan hastalar çalışmaya dahil edildi. Tedavi sonrası en az 1 yıllık takip süresini tamamlayamayan 12 hasta ve daha önce tedavi almış 9 hasta çalışma dışında bırakıldı. Tedavi başarısı olarak hasta memnuniyeti ve/veya visüel analog skorunda VAS %50’den fazla düşme kabul edildi.Bulgular: 26 kadın hastanın ortalama yaşı 42,8±10,2 32-59 idi. Tedavi yapılan 26 hastanın 5’i konservatif tedavi ve Amitriptilin tedavisinden fayda gördü. 26 hastanın 12’si PPS tedavisine geçmedi, 14 hastada PPS tedavisi uygulandı ve 3 hasta PPS tedavisinden fayda gördü. 11 hastaya HD önerildi, HD uygulanan 7 hastanın 3’ünde başarı sağlandı. İntrakaviter DMSO uygulanan 4 hastanın 2’si tedaviden fayda gördü. İntrakaviter BTİ uygulanan 4 hastanın 2’si tedaviden fayda gördü. Toplam 26 hastanın 11’i hiçbir tedaviden fayda görmedi.Sonuç: Ağrılı mesane sendromu tedavi uyumu kötü kronik bir hastalıktır. Tedavi basamaklarının düşük başarı oranları, hastaların tedaviye uyumunu zorlaştırmaktadır. Tedaviye yönteminde hem hasta hem de hekimin kesin iyileştirici tedavi olmadığının farkında olması ve tedavi sırasında bazı iyileşmelerin zaten bir zafer olduğunun bilinmesi tedavi uyumunu artırabilir.

Keywords

• İnterstisyel sistit,ağrılı mesane sendromu,tedavi

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