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Intravesical treatments of bladder pain syndrome/interstitial cystitis

Nature Reviews Urology volume 9, pages 707–720 (2012)Cite this article

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Abstract

Bladder pain syndrome/interstitial cystitis (BPS/IC) is a disabling chronic condition that affects up to 7% of women in the USA. In men, BPS/IC seems to be less common, but might be underestimated because it can be confused with chronic prostatitis. The aetiology and pathophysiology of BPS/IC are not well understood. Consequently, diagnosis and treatment is challenging and most therapies used to date are off-label. These therapies include bladder instillation with dimethyl sulfoxide (DMSO) and BCG, as well as hyperbaric oxygen therapy. Overall, botulinum neurotoxin A injection, intravesical sodium hyaluronate instillation and DMSO instillation seem to be the best-performing treatments, with response rates of 79%, 76% and 75%, respectively, and can be used effectively as second-line or third-line therapies for BPS/IC. However, additional high-quality randomized controlled trials are necessary to improve the available data.

Key Points

  • Bladder pain syndrome/interstitial cystitis (BPS/IC) is a disabling condition of growing incidence and considerable economic cost

  • BPS/IC diagnosis and treatment are hampered by the lack of knowledge of basic urinary bladder function and pathophysiology

  • However, the complex architecture of the urinary bladder provides various target structures for medicinal intervention

  • Although several intravesical treatments are available, most are off-label

  • Evidence from the literature supports the use of botulinum neurotoxin A injections, intravesical sodium hyaluronate instillation and instillation with dimethyl sulfoxide rather than glycosaminoglycan substitution or hyperbaric oxygen therapy

  • The literature on intravesical therapies is scant and more high-quality randomized controlled trials are necessary to improve available data

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Figure 1: Functional units of the urinary bladder wall.
Figure 2: Fine structure of the bladder.
Figure 3: The normal urothelium and denudation in BPS/IC.

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Acknowledgements

The authors thank Mrs Annett Weimann for the excellent technical assistance and Dr Hasan Qazi for critical reading and language editing of the manuscript.

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  1. Department of Urology, University of Leipzig, Liebigstraβe 20, Leipzig, 04103, Germany

    Jochen Neuhaus & Thilo Schwalenberg

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Neuhaus, J., Schwalenberg, T. Intravesical treatments of bladder pain syndrome/interstitial cystitis. Nat Rev Urol 9, 707–720 (2012). https://doi.org/10.1038/nrurol.2012.217

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