Advanced Management of Patients With Ulcerative Interstitial Cystitis/Bladder Pain Syndrome

Crescenze, Iryna; Gupta, Priyanka; Adams, Gayle; Oldendorf, Ann; Stoffel, John T.; Romo, Paholo G. Barboglio; Clemens, J. Quentin; Cameron, Anne P.

doi:10.1016/j.urology.2019.07.036

Cited by 13 publications

(26 citation statements)

References 20 publications

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“…Frequent side effects and the need for strict monitoring while on therapy has limited the use of CyA in clinical practice. However, Crescenze et al 46 reported novel data on a large cohort of patients with UIC, of which 47% (26/55) were treated with CyA with favourable results. The AUA guidelines consider CyA a fifth-line therapy, while the CUA guidelines list CyA as an option in patients refractory to other therapies.…”

Section: Cyclosporine Amentioning

confidence: 99%

“…49 Electrocautery fulguration, laser ablation, or resection of HL are accepted and recommended treatment options. 1,46 When comparing transurethral resection of HL to transurethral coagulation, Ko et al 50 found no significant difference in HL recurrence-free time (12.2 versus 11.5 months for transurethral resection versus coagulation; p=0.735). There was also no difference in symptomatic improvement between groups, but the transurethral resection group had an increased rate of bladder injury compared to transurethral coagulation (7.9% versus 3.4%).…”

Section: Ulcer Fulgurationmentioning

confidence: 99%

“…51,52 Observational studies report a 70-91% response rate that lasted between 7 and 12 months. 46,52 Repeat injections are likely to be required and thought to be safe. Dosing consists of 1 mL vial of triamcinolone (40 mg/mL) diluted in 9 cm 3 of injectable normal saline, which can then be injected in 1 cm 3 aliquots.…”

Section: Intralesion Triamcinolone Injectionmentioning

confidence: 99%

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Treatment of Interstitial Cystitis/Bladder Pain Syndrome: A Contemporary Review

2020

EMJ

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Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating condition affecting approximately 3% of the female population. IC/BPS is defined as an unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms for more than six weeks duration, in the absence of infection or other identifiable cause. This condition is known to have a profound negative impact on quality of life. There are few well-studied treatment options and no cure for this condition, which is therefore challenging to treat. The purpose of this narrative review is to summarise the contemporary literature, including the Canadian Urological Association (CUA) and American Urological Association (AUA) guidelines, on various treatment options that exist for IC/BPS, including conservative therapies, oral therapies, intravesical therapies, and more invasive surgical options. Most importantly, this review highlights the need for an individualised, multimodal approach to the treatment of IC/BPS.

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Section: Cyclosporine Amentioning

confidence: 99%

Section: Ulcer Fulgurationmentioning

confidence: 99%

Section: Intralesion Triamcinolone Injectionmentioning

confidence: 99%

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Treatment of Interstitial Cystitis/Bladder Pain Syndrome: A Contemporary Review

2020

EMJ

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“…Bladder dome or trigone injection with Botulinum toxin A, a neurotoxin, and triamcinolone, particularly in the presence of ulceration, have been studied [17,18]. Both have shown treatment benefit with a reduction in bladder pain; however, both are not curative and require repeated treatment.…”

mentioning

confidence: 99%

“…If ulcerations are identified at cystoscopy, transurethral fulguration or ablation or resection is recommended, producing symptom improvement in 50-81% of treated patients [18]. Medically recalcitrant cases may be suitable for sacral neuromodulation.…”

mentioning

confidence: 99%

Understanding bladder pain syndrome/interstitial cystitis

et al. 2020

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A pilot study on oral cyclosporine A in association with fulguration for the treatment of interstitial cystitis with Hunner's lesions

Brière

Bouchard

Ismail

et al. 2022

Neurourology and Urodynamics

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Aims To evaluate the efficacy and safety of lesion fulguration in combination with cyclosporine A (CyA) as a maintenance therapy in patients with interstitial cystitis/bladder pain syndrome (IC/BPS) with Hunner's lesion (HL). Methods Retrospective observational study of refractory patients with HL treated with daily 1.5 mg/kg or less of oral CyA following lesion fulguration. Pain severity, subjective improvement, urinary symptoms, and adverse events were used to assess long‐term treatment efficiency and safety. Results Among the 22 patients, median follow‐up under CyA was 27 months. Patients reported sustained significant reduction compared to pretreatment in pain (0/10 vs. 8/10; p < 0.001), urinary frequency per 24 h (9.5 vs. 20.8; p < 0.001), and nocturia (2.3 vs. 7.6; p < 0.001). Subjective improvement rate (SIR) and patient global impression of improvement were of 90% and 1 (“very much better”), respectively, including four patients who considered themselves cured (SIR: 100%). Three patients needed an additional procedure due to pain relapse. Minor increase in creatinine was observed and three patients developed or worsened their arterial hypertension. CyA dosage was decreased to 1.2 mg/kg or less for long‐term relief (n = 8), creatinine increase (n = 5), and neutropenia (n = 1) with subsequent improvement in renal function without symptom deterioration. Conclusions Oral CyA seems to allow a sustained long‐term relief following HL fulguration by alleviating pain, decreasing urinary symptoms, and procuring great subjective improvement. The daily low dose of 1.5 mg/kg or less appears to have limited adverse events while preventing repeated procedures. Larger trials are warranted.

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Advanced Management of Patients With Ulcerative Interstitial Cystitis/Bladder Pain Syndrome

Cited by 13 publications

References 20 publications

Treatment of Interstitial Cystitis/Bladder Pain Syndrome: A Contemporary Review

Treatment of Interstitial Cystitis/Bladder Pain Syndrome: A Contemporary Review

Understanding bladder pain syndrome/interstitial cystitis

A pilot study on oral cyclosporine A in association with fulguration for the treatment of interstitial cystitis with Hunner's lesions

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