Skip to main content

Advertisement

SpringerLink
Log in

Current Recommendations for Bladder Instillation Therapy in the Treatment of Interstitial Cystitis/Bladder Pain Syndrome

  • Lower Urinary Tract Symptoms and Voiding Dysfunction (G Badlani and H Goldman, Section Editors)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Bladder instillation therapy refers to the direct introduction of medication into the bladder and is a common treatment modality for patients with interstitial cystitis/bladder pain syndrome (IC/BPS) who have failed conservative and oral therapies. The current American Urological Association (AUA) recommendations list three medications as options for IC/BPS instillation therapy: dimethyl sulfoxide, heparin, and lidocaine. The purpose of this review is to examine the evidence behind the recommendations for these medications. We also examine several historical or experimental therapies that do not hold recommendations but are still used on rare occasion. Finally, we discuss our bladder instillation strategies as well as potential future research and development in intravesicular therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. •• Hanno PM et al. AUA guideline for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome. J Urol. 2011;185:2162–70. This document reflects all the current guidelines and recommendations from the AUA regarding interstitial cystitis/bladder pain syndrome.

    Article  PubMed  Google Scholar 

  2. Shirley SW, Stewart BH, Mirelman S. Dimethyl sulfoxide in treatment of inflammatory genitourinary disorders. Urology. 1978;11:215–20.

    Article  PubMed  CAS  Google Scholar 

  3. Kim R, Liu W, Chen X, Kreder KJ, Luo Y. Intravesical dimethyl sulfoxide inhibits acute and chronic bladder inflammation in transgenic experimental autoimmune cystitis models. J Biomed Biotechnol. 2011;2011:937061.

    PubMed  Google Scholar 

  4. Shiga K et al. Dimethyl sulphoxide relaxes rabbit detrusor muscle by decreasing the Ca2+ sensitivity of the contractile apparatus. Br J Pharmacol. 2007;151:1014–24.

    Article  PubMed  CAS  Google Scholar 

  5. Moldwin RM, Evans RJ, Stanford EJ, Rosenberg MT. Rational approaches to the treatment of patients with interstitial cystitis. Urology. 2007;69:S73–81.

    Article  Google Scholar 

  6. Hohlbrugger G, Lentsch P. Intravesical ions, osmolality and pH influence the volume pressure response in the normal rat bladder, and this is more pronounced after DMSO exposure. Eur Urol. 1985;11:127–30.

    PubMed  CAS  Google Scholar 

  7. Stav K, Beberashvili I, Lindner A, Leibovici D. Predictors of response to intravesical dimethyl-sulfoxide cocktail in patients with interstitial cystitis. Urology. 2012;80:61–5.

    Article  PubMed  Google Scholar 

  8. Parkin J, Shea C, Sant GR. Intravesical dimethyl sulfoxide (DMSO) for interstitial cystitis–a practical approach. Urology. 1997;49:105–7.

    Article  PubMed  CAS  Google Scholar 

  9. Barker SB, Matthews PN, Philip PF, Williams G. Prospective study of intravesical dimethyl sulphoxide in the treatment of chronic inflammatory bladder disease. Br J Urol. 1987;59:142–4.

    Article  PubMed  CAS  Google Scholar 

  10. Ghoniem GM, McBride D, Sood OP, Lewis V. Clinical experience with multiagent intravesical therapy in interstitial cystitis patients unresponsive to single-agent therapy. World J Urol. 1993;11:178–82.

    Article  PubMed  CAS  Google Scholar 

  11. Rössberger J, Fall M, Peeker R. Critical appraisal of dimethyl sulfoxide treatment for interstitial cystitis: discomfort, side-effects and treatment outcome. Scand J Urol Nephrol. 2005;39:73–7.

    Article  PubMed  Google Scholar 

  12. • Perez-Marrero R, Emerson LE, Feltis JT. A controlled study of dimethyl sulfoxide in interstitial cystitis. J Urol. 1988;140:36–9. One of the main randomized clinical trials showing the efficacy of DMSO.

    PubMed  CAS  Google Scholar 

  13. • Peeker R, Haghsheno MA, Holmäng S, Fall M. Intravesical bacillus Calmette-Guerin and dimethyl sulfoxide for treatment of classic and nonulcer interstitial cystitis: a prospective, randomized double-blind study. J Urol. 2000;164:1912–5. discussion 1915–1916. One of the main randomized clinical trials showing the efficacy of DMSO.

    Article  PubMed  CAS  Google Scholar 

  14. Slobodov G et al. Abnormal expression of molecular markers for bladder impermeability and differentiation in the urothelium of patients with interstitial cystitis. J Urol. 2004;171:1554–8.

    Article  PubMed  CAS  Google Scholar 

  15. Hurst RE et al. A deficit of chondroitin sulfate proteoglycans on the bladder uroepithelium in interstitial cystitis. Urology. 1996;48:817–21.

    Article  PubMed  CAS  Google Scholar 

  16. Hanno PM, Fritz R, Wein AJ, Mulholland SG. Heparin as antibacterial agent in rabbit bladder. Urology. 1978;12:411–5.

    Article  PubMed  CAS  Google Scholar 

  17. Kyker KD, Coffman J, Hurst RE. Exogenous glycosaminoglycans coat damaged bladder surfaces in experimentally damaged mouse bladder. BMC Urol. 2005;5:4.

    Article  PubMed  Google Scholar 

  18. Lane DA, Adams L. Non-anticoagulant uses of heparin. N Engl J Med. 1993;329:129–30.

    Article  PubMed  CAS  Google Scholar 

  19. • Parsons CL, Housley T, Schmidt JD, Lebow D. Treatment of interstitial cystitis with intravesical heparin. Br J Urol. 1994;73:504–7. The first major study demonstrating the efficacy of intravesicular heparin.

    Article  PubMed  CAS  Google Scholar 

  20. Parsons CL. Successful downregulation of bladder sensory nerves with combination of heparin and alkalinized lidocaine in patients with interstitial cystitis. Urology. 2005;65:45–8.

    Article  PubMed  Google Scholar 

  21. Butrick CW, Sanford D, Hou Q, Mahnken JD. Chronic pelvic pain syndromes: clinical, urodynamic, and urothelial observations. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20:1047–53.

    Article  PubMed  Google Scholar 

  22. Welk BK, Teichman JMH. Dyspareunia response in patients with interstitial cystitis treated with intravesical lidocaine, bicarbonate, and heparin. Urology. 2008;71:67–70.

    Article  PubMed  Google Scholar 

  23. Interstitial Cystitis Association. Bioniche trial. 2003.

  24. Reece JB, Urry L, Cain M, Wasserman S, Minorsky P, Jackson R. Campbell biology (9th edition; International edition.). Harlow: Pearson Education; 2011.

  25. Davis EL, El Khoudary SR, Talbott EO, Davis J, Regan LJ. Safety and efficacy of the use of intravesical and oral pentosan polysulfate sodium for interstitial cystitis: a randomized double-blind clinical trial. J Urol. 2008;179:177–85.

    Article  PubMed  CAS  Google Scholar 

  26. Henry RA. Re: safety and efficacy of the use of intravesical and oral pentosan polysulfate sodium for interstitial cystitis: a randomized double-blind clinical trial. Davis EL, El Khoudary SR, Talbott EO, Davis J, Regan LJ. J Urol 2008; 179: 177–185. J Urol. 180, 411–412; author reply 412–413 (2008).

  27. Nickel JC et al. A real-life multicentre clinical practice study to evaluate the efficacy and safety of intravesical chondroitin sulphate for the treatment of interstitial cystitis. BJU Int. 2009;103:56–60.

    Article  PubMed  Google Scholar 

  28. • Nickel JC et al. Intravesical alkalinized lidocaine (PSD597) offers sustained relief from symptoms of interstitial cystitis and painful bladder syndrome. BJU Int. 2009;103:910–8. The major study in the demonstrating the efficacy of intravesicular lidocaine.

    Article  PubMed  CAS  Google Scholar 

  29. Nickel JC et al. Continuous intravesical lidocaine treatment for interstitial cystitis/bladder pain syndrome: safety and efficacy of a new drug delivery device. Sci Transl Med. 2012;4:143ra100.

    Article  PubMed  Google Scholar 

  30. Boucher W et al. Intravesical nanocrystalline silver decreases experimental bladder inflammation. J Urol. 2008;179:1598–602.

    Article  PubMed  CAS  Google Scholar 

  31. Chancellor MB, De Groat WC. Intravesical capsaicin and resiniferatoxin therapy: spicing up the ways to treat the overactive bladder. J Urol. 1999;162:3–11.

    Article  PubMed  CAS  Google Scholar 

  32. Payne CK et al. Intravesical resiniferatoxin for the treatment of interstitial cystitis: a randomized, double-blind, placebo controlled trial. J Urol. 2005;173:1590–4.

    Article  PubMed  CAS  Google Scholar 

  33. Chen TYH, Corcos J, Camel M, Ponsot Y, Tu LM. Prospective, randomized, double-blind study of safety and tolerability of intravesical resiniferatoxin (RTX) in interstitial cystitis (IC). Int Urogynecol J Pelvic Floor Dysfunct. 2005;16:293–7.

    Article  PubMed  CAS  Google Scholar 

  34. Peters K et al. The efficacy of intravesical Tice strain bacillus Calmette-Guerin in the treatment of interstitial cystitis: a double-blind, prospective, placebo controlled trial. J Urol. 1997;157:2090–4.

    Article  PubMed  CAS  Google Scholar 

  35. Peters KM, Diokno AC, Steinert BW, Gonzalez JA. The efficacy of intravesical bacillus Calmette-Guerin in the treatment of interstitial cystitis: long-term followup. J Urol. 1998;159:1483–6. discussion 1486–1487.

    Article  PubMed  CAS  Google Scholar 

  36. Mayer R et al. A randomized controlled trial of intravesical bacillus calmette-guerin for treatment refractory interstitial cystitis. J Urol. 2005;173:1186–91.

    Article  PubMed  Google Scholar 

  37. Izes JK, Bihrle 3rd W, Thomas CB. Corticosteroid-associated fatal mycobacterial sepsis occurring 3 years after instillation of intravesical bacillus Calmette-Guerin. J Urol. 1993;150:1498–500.

    PubMed  CAS  Google Scholar 

  38. Lamm DL et al. Incidence and treatment of complications of bacillus Calmette-Guerin intravesical therapy in superficial bladder cancer. J Urol. 1992;147:596–600.

    PubMed  CAS  Google Scholar 

  39. Nickel JC. Placebo controlled study of safety, tolerability, and efficacy of LiRIS in women with interstitial cystitis, followed by open-label extension. IN: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000. Available from: http://clinicaltrials.gov/ct2/show/NCT01475253. Cited 2013 Sept

  40. Haifler M, Assaf-Harofeh Medical Center. DMSO Efficacy in IC/PBS patients during and after treatment IN: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000. Available from: http://www.clinicaltrials.gov/ct2/show/NCT01074567. NCT identifier:01074567. Cited 2013 Sept.

  41. Fraser MO, Chuang YC, Tyagi P, et al. Intravesical liposome administration – a novel treatment for hyperactive bladder in the rat. Urology. 2003;61:656–663.

    Google Scholar 

  42. Chuang YC, Lee WC, Chiang PH. Intravesical liposome versus oral pentosan polysulfate for interstitial cystitis/painful bladder syndrome. J. Urol. 2009;182:1393–1400.

    Google Scholar 

  43. Kaufman J, Lipella Pharmaceuticals Inc. Efficacy of Intravesical LP08 in patients with interstitial cystitis/painful bladder syndrome. IN: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). 2000. Available from: http://clinicaltrials.gov/show/NCT01393223. NCT identifier: 01393223. Cited 2013 Sept

  44. Parsons CL. Evidence-based strategies for recognizing and managing interstitial cystitis. Contemp. Urol. 2003;15(2):22–35

    Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Dr. Marc A. Colaco reported no potential conflicts of interest relevant to this article.

Dr. Robert J. Evans serves on the board of directors for Interstitial Cystitis Assoc. and has received consultancy from Medtronic. Dr. Evans holds stock/stock options in Urigen Pharmaceuticals and has has travel/accommodations expenses covered or reimbursed by Medtronic.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Department of Urology, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC, 27157, USA

    Marc A. Colaco & Robert J. Evans

Authors
  1. Marc A. Colaco
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert J. Evans
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert J. Evans.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Colaco, M.A., Evans, R.J. Current Recommendations for Bladder Instillation Therapy in the Treatment of Interstitial Cystitis/Bladder Pain Syndrome. Curr Urol Rep 14, 442–447 (2013). https://doi.org/10.1007/s11934-013-0369-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11934-013-0369-y

Keywords

Search

Navigation