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Treatment Management In Interstitial Cystitis/Painful Bladder Syndrome

Year 2018, Volume: 15 Issue: 2, 66 - 69, 01.04.2018

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.

References

  • Abrams P, Cardozo L, Fall M,Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub committee of the International Continence So- ciety. Neurourol Urodyn 2002;21:167-78.
  • Warren JW, Diggs C, Brown V, Meyer WA, Markowitz S, Greenberg P. Dy- suria at onset of interstitial cystitis/painful bladder syndrome in women. Urology 2006; 68(3): 477-481.
  • Oravisto KJ. Epidemiology of interstitial cystitis. Ann Chir Gynaecol Fenn 1975; 64:75-77
  • Clemens JQ, Meenan RT, O’Keeffe Rosetti MC, Brown SO, Gao SY, Cal- houn EA Prevalence of interstitial cystitis symptoms in a managed care population. J Urol 2005; 174:576-580
  • Tomaszewski JE, Landis JR, Russack V, Williams TM, Wang LP, Hardy C, et al. Biopsy features are associated with primary symp toms in intersti- tial cystitis: results from the interstitial cystitis data base study. Urology 2001;57(6 Suppl 1):67-81.
  • Nordling J, Anjum FH, Bade JJ, Bouchelouche K, Bouchelouche P, Cervig- ni M, et al. Primary evaluation of patients suspected of hav ing interstitial cystitis (IC). Eur Urol 2004;45:662-9.
  • Bogart LM, Berry SH, Clemens JQ. Symptoms of interstitial cysti tis, painful bladder syndrome and similar diseases in women: a systematic review. J Urol 2007;177:450-6.
  • Nickel JC, Tripp DA, Pontari M,Moldwin R, Mayer R, Carr L, et al. Inters- titial cystitis/painful bladder syndrome and associated medical conditions with an emphasis on irritable bowel syndrome, fibromyalgia and chronic fatigue syndrome. J Urol. 2010;184(4):1358-63.
  • Warren JW, Wesselmann U, Morozov V, Langenberg PW. Numbers and types of nonbladder syndromes as risk factors for interstitial cystitis/pa- inful bladder syndrome. Urology. 2011 Feb;77(2):313-9.
  • Berry SH, Elliott MN, Suttorp M, Bogart LM, Stoto MA, Eggers P, et al. Pre- valence of symptoms of bladder pain syndrome/interstitial cystitis among adult females in the United States. J Urol 2011;186:540-4.
  • Whitmore KE. Self care regimes for patients with interstitial cystitis. Urol Clin North Am 1994;21:121-30.
  • Bade JJ, Peeters JM, Mensink HJ. Is the diet of patients with interstitial cystitis related to their disease?. European urology, 1996; 32(2): 179- 183.
  • Chaiken DC, Blaivas JG, Blaivas ST. Behavioral therapy for the treatment of refractory interstitial cystitis. The Journal of urology 1993; 149(6), 1445-8.
  • McQuay HJ, Moore RA. Antidepressants and chronic pain. BMJ: British Medical Journal, 1997;314:763.
  • Rovner E, Propert KJ, Brensinger C,Wein AJ, Foy M, Kirkemo A, et al. Treatments used in women with interstitial cystitis: the interstitial cysti- tis data base (ICDB) study experience. The Interstitial Cystitis Data Base Study Group. Urology 2000;56:940.
  • van Ophoven A, Pokupic S, Heinecke A,Hertle L . A prospective, ran- domized, placebo controlled, doubleblind study of amitriptyline for the treatment of interstitial cystitis. J Urol 2004;172:533.
  • Foster HE, Hanno PM, Nickel JC, Payne CK, Mayer RD, Burks DA, et al. Effect of amitriptyline on symptoms in treatment naive patients with in- terstitial cystitis/painful bladder syndrome. The Journal of urology, 2010; 183(5):1853-8.
  • Moutzouris DA, Falagas ME. Interstitial cystitis: an unsolved enigma. Clin J Am Soc Nephrol. 2009;4(11):1844-57.
  • Hanno P. International consultation on IC–Rome, September 2004/For- ging an international consensus: Progress in painful bladder syndrome/ interstitial cystitis. International Urogynecology Journal 2005; 16(1): 2-34.
  • Fall M, Oberpenning F, Peeker R. Treatment of bladder pain syndrome/ interstitial cystitis 2008: can we make evidence-based decisions? Eur Urol. 2008 Jul;54(1):65-75.
  • Aihara K, Hirayama A, Tanaka N, Fujimoto K, Yoshida K, Hirao Y. Hyd- rodistension under local anesthesia for patients with suspected painful bladder syndrome/interstitial cystitis: safety, diagnostic potential and the- rapeutic efficacy. Int J Urol. 2009;16(12):947-52.
  • Nordling J. Interstitial cystitis: how should we diagnose it and treat it in 2004? Curr Opin Urol. 2004;14(6):323-7.
  • Pinto R, Lopes T, Frias B,Silva A, Silva JA, Silva CM, et al. Trigonal injecti- on of botulinum toxin A in patients with refractory bladder pain syndrome/ interstitial cystitis. Eur Urol 2010; 58:360-5.
  • Kuo HC, Chancellor MB. Comparison of intravesical botulinum toxin type A injections plus hydrodistention with hydrodistention alone for the tre- atment of refractory interstitial cystitis/painful bladder syndrome. BJU international 2009; 104: 657-61

İnterstisyel Sistit/Ağrılı Mesane Sendromunda Tedavi Yönetimi

Year 2018, Volume: 15 Issue: 2, 66 - 69, 01.04.2018

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.

References

  • Abrams P, Cardozo L, Fall M,Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub committee of the International Continence So- ciety. Neurourol Urodyn 2002;21:167-78.
  • Warren JW, Diggs C, Brown V, Meyer WA, Markowitz S, Greenberg P. Dy- suria at onset of interstitial cystitis/painful bladder syndrome in women. Urology 2006; 68(3): 477-481.
  • Oravisto KJ. Epidemiology of interstitial cystitis. Ann Chir Gynaecol Fenn 1975; 64:75-77
  • Clemens JQ, Meenan RT, O’Keeffe Rosetti MC, Brown SO, Gao SY, Cal- houn EA Prevalence of interstitial cystitis symptoms in a managed care population. J Urol 2005; 174:576-580
  • Tomaszewski JE, Landis JR, Russack V, Williams TM, Wang LP, Hardy C, et al. Biopsy features are associated with primary symp toms in intersti- tial cystitis: results from the interstitial cystitis data base study. Urology 2001;57(6 Suppl 1):67-81.
  • Nordling J, Anjum FH, Bade JJ, Bouchelouche K, Bouchelouche P, Cervig- ni M, et al. Primary evaluation of patients suspected of hav ing interstitial cystitis (IC). Eur Urol 2004;45:662-9.
  • Bogart LM, Berry SH, Clemens JQ. Symptoms of interstitial cysti tis, painful bladder syndrome and similar diseases in women: a systematic review. J Urol 2007;177:450-6.
  • Nickel JC, Tripp DA, Pontari M,Moldwin R, Mayer R, Carr L, et al. Inters- titial cystitis/painful bladder syndrome and associated medical conditions with an emphasis on irritable bowel syndrome, fibromyalgia and chronic fatigue syndrome. J Urol. 2010;184(4):1358-63.
  • Warren JW, Wesselmann U, Morozov V, Langenberg PW. Numbers and types of nonbladder syndromes as risk factors for interstitial cystitis/pa- inful bladder syndrome. Urology. 2011 Feb;77(2):313-9.
  • Berry SH, Elliott MN, Suttorp M, Bogart LM, Stoto MA, Eggers P, et al. Pre- valence of symptoms of bladder pain syndrome/interstitial cystitis among adult females in the United States. J Urol 2011;186:540-4.
  • Whitmore KE. Self care regimes for patients with interstitial cystitis. Urol Clin North Am 1994;21:121-30.
  • Bade JJ, Peeters JM, Mensink HJ. Is the diet of patients with interstitial cystitis related to their disease?. European urology, 1996; 32(2): 179- 183.
  • Chaiken DC, Blaivas JG, Blaivas ST. Behavioral therapy for the treatment of refractory interstitial cystitis. The Journal of urology 1993; 149(6), 1445-8.
  • McQuay HJ, Moore RA. Antidepressants and chronic pain. BMJ: British Medical Journal, 1997;314:763.
  • Rovner E, Propert KJ, Brensinger C,Wein AJ, Foy M, Kirkemo A, et al. Treatments used in women with interstitial cystitis: the interstitial cysti- tis data base (ICDB) study experience. The Interstitial Cystitis Data Base Study Group. Urology 2000;56:940.
  • van Ophoven A, Pokupic S, Heinecke A,Hertle L . A prospective, ran- domized, placebo controlled, doubleblind study of amitriptyline for the treatment of interstitial cystitis. J Urol 2004;172:533.
  • Foster HE, Hanno PM, Nickel JC, Payne CK, Mayer RD, Burks DA, et al. Effect of amitriptyline on symptoms in treatment naive patients with in- terstitial cystitis/painful bladder syndrome. The Journal of urology, 2010; 183(5):1853-8.
  • Moutzouris DA, Falagas ME. Interstitial cystitis: an unsolved enigma. Clin J Am Soc Nephrol. 2009;4(11):1844-57.
  • Hanno P. International consultation on IC–Rome, September 2004/For- ging an international consensus: Progress in painful bladder syndrome/ interstitial cystitis. International Urogynecology Journal 2005; 16(1): 2-34.
  • Fall M, Oberpenning F, Peeker R. Treatment of bladder pain syndrome/ interstitial cystitis 2008: can we make evidence-based decisions? Eur Urol. 2008 Jul;54(1):65-75.
  • Aihara K, Hirayama A, Tanaka N, Fujimoto K, Yoshida K, Hirao Y. Hyd- rodistension under local anesthesia for patients with suspected painful bladder syndrome/interstitial cystitis: safety, diagnostic potential and the- rapeutic efficacy. Int J Urol. 2009;16(12):947-52.
  • Nordling J. Interstitial cystitis: how should we diagnose it and treat it in 2004? Curr Opin Urol. 2004;14(6):323-7.
  • Pinto R, Lopes T, Frias B,Silva A, Silva JA, Silva CM, et al. Trigonal injecti- on of botulinum toxin A in patients with refractory bladder pain syndrome/ interstitial cystitis. Eur Urol 2010; 58:360-5.
  • Kuo HC, Chancellor MB. Comparison of intravesical botulinum toxin type A injections plus hydrodistention with hydrodistention alone for the tre- atment of refractory interstitial cystitis/painful bladder syndrome. BJU international 2009; 104: 657-61
There are 24 citations in total.

Details

Primary Language Turkish
Journal Section Research Article
Authors

Oğuz Mertoğlu This is me

Salih Budak This is me

Cem Yücel This is me

Erdem Kısa This is me

Zafer Kocaoğlu This is me

Publication Date April 1, 2018
Published in Issue Year 2018 Volume: 15 Issue: 2

Cite

Vancouver Mertoğlu O, Budak S, Yücel C, Kısa E, Kocaoğlu Z. İnterstisyel Sistit/Ağrılı Mesane Sendromunda Tedavi Yönetimi. JGON. 2018;15(2):66-9.