Intravesical Therapy for BPS/IC

This manuscript gives a recent overview of intravesical treatments in patients with bladder pain syndrome/interstitial cystitis (BPS/IC). The newest data on GAG replenishment therapy, intravesical local anaesthetics, DMSO, botulinum toxin, experimental drugs, and ways of application are discussed.

The literature data show symptomatic therapeutic successes in a limited number of patients with most treatments discussed here. The heterogeneity of BPS/IC, the absence of clear knowledge of the cause in each patient, the different phenotypes included in the same research sample, the variability of dosage, and application frequency make interpretation of study results difficult. Treatment can aim at restoring a deficient GAG, to block the pain with local analgesics, and to lessen local inflammation, but it is uncertain from which treatment an individual patient will benefit most: trial and error are mostly used. Exclusion of many confusable diseases and Hunner lesions is the first step to indicate the treatment options with the most chance of success.

The actual trial and error approach is the only available way so far for intravesical treatment in patients with BPS/IC. The overall results are acceptable, but a better understanding of the symptom syndrome and better phenotyping of BPS/IC patients will most probably improve the outcome in individual patients.