A combined intravesical therapy with hyaluronic acid and chondroitin for refractory painful bladder syndrome/interstitial cystitis Safety and dose flexibility clinical evaluation of intravesical liposome in patients with interstitial cystitis or painful bladder syndrome. Multimodal therapy for painful bladder syndrome / interstitial cystitis: pilot study combining behavioral, pharmacologic, and endoscopic therapies. Results of endovesical hyaluronic acid/chondroitin sulfate in the treatment of Interstitial Cystitis/Painful Bladder Syndrome. Intravesical hyaluronic acid and alkalinized lidocaine for the treatment of severe painful bladder syndrome/interstitial cystitis The Clinical Effectiveness of Intravesical Sodium Hyaluronate (Cystistat®) in Patients with Interstitial Cystitis/Painful Bladder Syndrome and Recurrent Urinary Tract Infections Treatment of interstitial cystitis with Cystistat®, A hyaluronic acid product A multicenter, randomized, double-blind, parallel group pilot evaluation of the efficacy and safety of intravesical sodium chondroitin sulfate versus vehicle control in patients with interstitial cystitis/painful bladder syndrome. Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome and pelvic floor tenderness. Etiology, pathogenesis, and diagnosis of interstitial cystitis. Research criteria versus clinical criteria for interstitial cystitis. Short-term results of bilateral S2-S4 sacral neuromodulation for the treatment of refractory interstitial cystitis, painful bladder syndrome, and chronic pelvic pain. A real‐life multicentre clinical practice study to evaluate the efficacy and safety of intravesical chondroitin sulphate for the treatment of interstitial cystitis Combined intravesical sodium hyaluronate/chondroitin sulfate therapy for interstitial cystitis/bladder pain syndrome: a prospective study Intravesical alkalinized lidocaine (PSD597) offers sustained relief from symptoms of interstitial cystitis and painful bladder syndrome Botulinum toxin a has antinociceptive effects in treating interstitial cystitis. Intravesical hyaluronic acid in the treatment of refractory interstitial cystitis. Impact of intravesical hyaluronic acid and chondroitin sulfate on bladder pain syndrome/interstitial cystitis Transdermal posterior tibial nerve laser therapy is not effective in women with interstitial cystitis. Increased risk of bladder cancer following diagnosis with bladder pain syndrome/interstitial cystitis. Multiple Intravesical Instillations of Low-Dose Resiniferatoxin in the Treatment of Refractory Interstitial Cystitis Bladder Pain Syndrome Treated with Triple Therapy with Gabapentin, Amitriptyline, and a Nonsteroidal Anti-Inflammatory Drug Comparative assessment of maximal bladder capacity, 0.9% NaCl versus 0.2 M Kcl, for the diagnosis of interstitial cystitis: a prospective controlled study. A prospective, double‐blind, randomized cross‐over study evaluating changes in urinary pH for relieving the symptoms of interstitial cystitis Treatment of interstitial cystitis with a quercetin supplement. A pilot clinical trial of oral pentosan polysulfate and oral hydroxyzine in patients with interstitial cystitis.
The aims of this study were to evaluate the efficacy and tolerability of intravesical instillations of high-molecular-weight hyaluronic acid ( HA ) 1.6 % and chondroitin sulfate ( CS ) 2.0 % in patients with refractory painful bladder syndrome/interstitial cystitis ( PBS/IC ) and to observe their impact on Quality of Life . Twenty-three women were enrolled . They received bladder instillations with HA and CS weekly for 20 weeks and then monthly for 3 months . Mean follow-up after completion of therapy was 5 months . We observed a significant improvement in urinary symptoms on voiding diaries and Visual Analogue Scale for frequency ( p = 0.045 ) , urgency ( p = 0.005 ) , and pain ( p = 0.001 ) . The O’Leary – Sant Interstitial Cystitis Symptom Index and Interstitial Cystitis Problem Index result ed in a significant improvement in both scores ( p = 0.004 and 0.01 , respectively ) . The Pelvic Pain and Urgency/Frequency Symptom Scale only showed significant improvement in the symptom score ( p = 0.001 ) . This promising experience seems to offer an additional therapeutic option in patients with refractory PBS/IC To present single institution open-label experience with intravesical liposomes ( LPs ) , a mucosal protective agent , in patients with interstitial cystitis/painful bladder syndrome ( IC/PBS ) and to assess the safety and efficacy on IC/PBS symptoms . A total of 17 symptomatic IC/PBS patients were treated with intravesical LPs ( 80mg/40mL distilled water ) once a week for 4 weeks ( n=12 ) or twice a week treatment for 4 weeks ( n=5 ) . The primary outcome was the change in the O'Leary-Sant Symptom/Problem score and O'Leary-Sant total Score from baseline to Week 4 and Week 8 . Other outcome measurements included the changes in pain scale , urgency scale , voiding log , and patient global assessment . Both weekly and biweekly LP instillation regiments were well tolerated . The incidence of urinary incontinence , retention , or unanticipated adverse changes was not noted at any dose either during the treatment or at the 4-week follow-up . The O'Leary-Sant Symptom/Problem score , O'Leary-Sant total Score , and pain score were significantly improved from baseline at both dose regimens with added benefit with the biweekly regimen . Intravesical LPs treatment is safe and its efficacy has sustained duration . Furthermore large-scale , placebo-controlled studies are warranted to assess the efficacy for this promising new treatment for IC/PBS PURPOSE We evaluated the effectiveness of combining behavioral therapy , pharmacologic therapy and endoscopic hydrodistension for treating  painful bladder syndrome / interstitial cystitis ( PBS/IC ) .  MATERIAL S AND METHODS Twenty-five patients with PBS/IC were prospect ively enrolled in a pilot multimodal behavioral , pharmacologic and endoscopic treatment protocol . Behavioral modification included diet recommendations , fluid restriction to 64 oz . /day , progressive timed voiding and Kegel exercises . Oral pharmacologic therapy consisted of daily doses of macrodantin 100 mg , hydroxyzine 10 - 20 mg and urised 4 tablets .  Patients underwent endoscopic bladder hydrodistention under anesthesia  at least 2 weeks after protocol enrollment . Behavioral and pharmacological treatments were continued after the hydrodistention . O'Leary-Sant question naire scores were recorded before starting the protocol , after pharmacologic/behavioral therapy , 2 months post-hydrodistension , and at scheduled follow-up . RESULTS Eighteen patients ( 72 % ) completed the pilot multimodal treatment protocol and were followed for a mean of 10.2 months . All patients were female with a median age of 36.3 years and had mean bladder capacity under anesthesia of 836 milliliters .  Mean O'Leary-Sant symptom index scores for baseline symptoms , after behavioral/pharmacologic treatment , post-hydrodistension and during follow up were 12.5 , 8.6 , 7.0 , and 6.7 ( p < 0.05 ) . Mean O'Leary-Sant problem index scores for baseline , after behavioral/pharmacologic treatment , post-hydrodistention and during follow up were 12.7 , 8.9 , 6.7 , and 7.7 ( p < 0.05 ) . CONCLUSION Our pilot multimodal protocol of behavioral modification , pharmacologic therapy and endoscopic hydrodistention demonstrated a significant progressive improvement in PBS/IC quality of life scores , compared to a pre-treatment baseline . These results should be vali date d in a larger , placebo controlled trial OBJECTIVES The aim of our study was to test the effect of a more viscous compound than existent hyaluronic acid formulation in helping to restore a defective glycosaminoglycan layer , and therefore in improving Interstitial Cystitis/Painful Bladder Syndrome ( IC/PBS ) symptoms when administered intravesically in IC/PBS patients . METHODS A total of 23 female patients completed the study . Patients received endovesical administration of hyaluronic acid and chondroitin sulfate in normal saline , 40 ml , weekly for 12 weeks and then bi-weekly for 6 months , if there was initial response . RESULTS After 12 weeks treatment both Interstitial Cystitis Symptom and Problem Index ( ICSI/ICPI ) , pelvic pain and Urgency/Frequency Symptom Scale ( PUF ) showed a mean significant improvement , which was maintained thereafter . The average number of voidings and mean voiding volumes revealed significant improvement after the 12 weeks ' treatment period , with a significant reduction and increase , respectively . Mean voiding volume increased from 143 ml to 191 , which apparently was not reflected in a corresponding reduction of number of daily voids ( from 15,5 to 14 ) . VAS values decreased from 5,4 to 3,6 ( pain ) and from 6,0 to 3,5 ( urgency ) after the treatment cycle , showing a significant improvement . CONCLUSIONS In our preliminary experience , the administration of intravesical hyaluronic acid plus chondroitine sulphate appears to be a safe and efficacious method of treatment in IC/PBS Introduction and hypothesisIntravesical instillation of hyaluronic acid ( HA ) may restore the integrity of glycosaminoglycan layer in patients with painful bladder syndrome/interstitial cystitis ( PBS/IC ) , and the benefit may be improved with addition of alkalinized lidocaine ( AL ) . Methods 48 women with severe PBS/IC who failed oral medications were enrolled and divided into one trial and two control groups . The trial group received intravesical 40 mg HA , 10 ml of 2 % lidocaine and 5 ml of 8.4 % sodium bicarbonate on a weekly basis for 8 weeks and then monthly for 4 months with a subsequent follow-up of 24 weeks , while the two control groups received 40 mg HA and mixture of 10 ml of 2 % lidocaine and 5 ml of 8.4%sodium bicarbonate respectively following the same procedure . Response to therapy was evaluated by Global Response Assessment , voids per day , Visual Analogue Scale for pain , frequency and urgency , O’leary-Sant Interstitial Cystitis Symptom Index and Problem Index , cystoscopy and bladder capacity . Results Overall 45 patients finished this study protocol . The HA + AL group and the AL group showed significant improvement at week 2 ( P < 0.01 ) , while the HA group began to show effect at week 4 ( P < 0.01 ) . There was no improvement in the AL group at week 24 and these patients quitted the study without follow up . Contrarily , the HA + AL and HA group kept on improving till the end of the study without significant difference between the two groups . Conclusions Intravesical instillation of HA and AL may provide both immediate and sustained relief of symptoms in severe PBS/IC in this preliminary study Objective : Painful bladder syndrome/interstitial cystitis ( PBS/IC ) and recurrent urinary tract infections ( UTI ) are clinical ly challenging conditions to manage in patients . We evaluate the clinical use of intravesical sodium hyaluronate ( Cystistat ® ) in both these patient groups who have completed treatment . Patients and Methods : Thirteen patients with recurrent UTIs ( Group I ) and 8 patients with PBS/IC ( Group II ) received intravesical sodium hyaluronate ( Cystistat ® ) . Preinstallation demographic parameters were statically comparable in both groups . The mean age of presentation was 54.6 years in Group I and 57.5 years in Group II ( p = 0.9 ) . All 13 patients in Group I were on low dose antibiotics . The mean number of installations completed in both groups was 9 ( range 4–21 ) . Results : Data was collected prospect ively using a st and ard pre- and post-treatment question er with the pelvic pain and urinary/frequency patient symptom scale . At a mean follow-up of 21 months a significant improvement in bladder pain ( p = 0.05 ) , daytime frequency ( p = 0.03 ) and quality of life ( p = 0.02 ) was noted in patients in Group I. Two patients had breakthrough UTIs during treatment . Within Group I , 7 ( 53 % ) patients responded well to treatment . Patients in Group II had a significant improvement in bladder pain ( p = 0.02 ) , urgency ( p = 0.01 ) , nocturia ( p = 0.01 ) and quality of life ( p = 0.04 ) . Within Group II , 6 patients ( 75 % ) responded to treatment . Conclusion : Intravesical sodium hyaluronate ( Cystistat ® ) can be used with minimal side effects and good compliance in both groups of patients with PBS and recurrent UTIs . Longer follow-up and larger patient numbers in both groups will be required to confirm the long-term efficacy of these two clinical ly challenging groups of patients Objective . To determine whether intravesical hyaluronic acid is effective in reducing the urinary frequency and pain associated with interstitial cystitis/painful bladder syndrome ( IC/PBS ) . Material and methods . In a prospect i ve , unblinded , uncontrolled pilot study , 20 patients ( age range 34–80 years ) , all suffering from IC/PBS , received weekly bladder instillations of hyaluronic acid for 1 month and monthly instillations for a further 2 months . Patients were then offered further monthly instillations and all were subsequently evaluated after 3 years . Patient outcomes assessed were urinary frequency , use of analgesics and pain . Results . All patients completed the 3 months of hyaluronic acid treatment with mean decreases in nocturia and pain of 40 % and 30 % , respectively , and a decrease in analgesic use . Thirteen patients ( 65 % ) responded to treatment ( responders ) and continued therapy , while seven patients withdrew , six because of a lack of response and one due to cystectomy . In the 13 patients who continued hyaluronic acid instillations , four complete responders ( 30 % ) ceased therapy after a strong positive response ( 36 % , 60 % and 81 % decreases compared to baseline in day-time voids , night-time voids and pain scores , respectively ) which was maintained in the absence of continuous therapy , while after 3 years seven partial responders ( 35 % ) were still on therapy ( 25 % and 43 % decreases compared to baseline in day-time voids and pain scores , respectively ) . Two patients developed other diseases during follow-up and showed no response to long-term therapy . Hyaluronic acid was well tolerated by all patients . Conclusion . Hyaluronic acid safely reduced the pain and , to a lesser degree , the urinary frequency associated with IC OBJECTIVE The goal of this pilot study was to gather information on differences between intravesical chondroitin sulfate and inactive vehicle control for treatment of interstitial cystitis/painful bladder syndrome ( IC/PBS ) . METHODS This was a prospect i ve , r and omized , double-blind , inactive vehicle-controlled , 12-week study ( 6-week treatment period , followed by a 6-week follow-up period ) in patients with IC/PBS . Patients were r and omized to weekly intravesical treatment with 2.0 % sodium chondroitin sulfate in phosphate-buffered saline or intravesical vehicle control . Primary efficacy analysis compared responders ( moderately or markedly improved ) according to the 7-point Global Response Assessment . Secondary endpoints include question naires focused on symptoms and quality of life . RESULTS Sixty-five evaluable patients were r and omized . At the primary endpoint analysis ( week 7 ) , 22.6 % of the vehicle control group were responders compared with 39.4 % of the active therapy group ( P = .15 ) . There was no statistically significant difference for any of the secondary endpoints . Overall , 76.9 % of the patients in the study reported at least 1 adverse event ; most were mild or moderate , the majority associated with the vehicle control treatment . Nine nonserious intervention-related adverse events were reported in 3 patients in the vehicle control group compared with 2 in 1 patient in the active treatment group . CONCLUSION The difference in treatment effect in this small underpowered study was not statistically significant , although twice as many patients reported a clinical ly significant benefit with intravesical chondroitin sulfate treatment compared with vehicle control treatment . This trial provides data required to design a well-powered r and omized vehicle-controlled trial to determine the true efficacy of this potentially promising therapy PURPOSE We determined the efficacy and safety of pelvic floor myofascial physical therapy compared to global therapeutic massage in women with newly symptomatic interstitial cystitis/painful bladder syndrome . MATERIAL S AND METHODS A r and omized controlled trial of 10 scheduled treatments of myofascial physical therapy vs global therapeutic massage was performed at 11 clinical centers in North America . We recruited women with interstitial cystitis/painful bladder syndrome with demonstrable pelvic floor tenderness on physical examination and a limitation of no more than 3 years ' symptom duration . The primary outcome was the proportion of responders defined as moderately improved or markedly improved in overall symptoms compared to baseline on a 7-point global response assessment scale . Secondary outcomes included ratings for pain , urgency and frequency , the O'Leary-Sant IC Symptom and Problem Index , and reports of adverse events . We compared response rates between treatment arms using the exact conditional version of the Mantel-Haenszel test to control for clustering by clinical center . For secondary efficacy outcomes cross-sectional descriptive statistics and changes from baseline were calculated . RESULTS A total of 81 women r and omized to the 2 treatment groups had similar symptoms at baseline . The global response assessment response rate was 26 % in the global therapeutic massage group and 59 % in the myofascial physical therapy group ( p=0.0012 ) . Pain , urgency and frequency ratings , and O'Leary-Sant IC Symptom and Problem Index decreased in both groups during followup , and were not significantly different between the groups . Pain was the most common adverse event , occurring at similar rates in both groups . No serious adverse events were reported . CONCLUSIONS A significantly higher proportion of women with interstitial cystitis/painful bladder syndrome responded to treatment with myofascial physical therapy than to global therapeutic massage . Myofascial physical therapy may be a beneficial therapy in women with this syndrome Interstitial cystitis ( IC ) is a bladder syndrome of unknown etiology . The cause of IC is most likely multifactorial and includes genetic and environmental factors . Various pathophysiological changes in the bladder , pelvis , and peripheral and central nervous systems have been identified , and this has led to the emergence of biologically specific treatment modalities . Interstitial cystitis is being diagnosed with increasing frequency ; however , current diagnostic criteria are non-uniform , and there is significant overlap between chronic pelvic pain syndromes in men and women , interstitial cystitis , recurrent " cystitis , " and the overactive bladder syndrome . The diagnosis of interstitial cystitis can be made clinical ly and by cystoscopy and hydrodistension . The sensitivity and specificity of urinary markers and the potassium sensitivity test have not been prospect ively studied In March 2003 experts on interstitial cystitis ( IC ) from around the world met in Kyoto , Japan for a series of workshops intended to define areas of agreement and difference in the approach to this disease . This workshop explored the diagnostic criteria IC in the clinical and research setting s. The NIDDK criteria are used almost universally for research but there is tremendous disparity in the clinics and no consensus at all as to the best practice in diagnosing IC for clinical purpose s. Throughout the world many physicians use the NIDDK research criteria for clinical diagnosis ; in some countries this is st and ard . Undoubtedly , this m and ates under-diagnosis and denies treatment to many patients . Still , a majority feel that one diagnostic system is m and atory to promote clarity in communication . The group called for two initiatives to help advance this area of controversy : ( 1 ) a large-scale , prospect i ve study critically examining the role of  cystoscopy , bladder distention , and biopsy  in the diagnosis of IC ; ( 2 ) a concerted effort to develop a single evidence -based guideline or algorithm that would be flexible enough to meet the needs of clinicians , research ers , and patients We evaluated the efficacy of bilateral caudal epidural sacral neuromodulation for the treatment of refractory chronic pelvic pain ( CPP ) , painful bladder syndrome , and interstitial cystitis ( IC ) . Thirty consecutive patients ( 21 female , 9 male ) with severe refractory symptoms underwent bilateral S2-S4 sacral neuromodulation for CPP/IC . Patients were evaluated with the O'Leary IC symptom and problem index ( ICSI , ICPI ) , the short form of the Urogenital Distress Inventory ( UDI-6 ) , and the R AND 36-item health survey ( SF-36 ) preoperatively and 6 months postoperatively . The mean and minimum follow-up were 15 and 6 months , respectively . Of the 30 patients , 23 ( 77 % ) had a successful trial stimulation and were permanently implanted . Among these patients , the ICSI and ICPI scores improved by 35 ( p = 0.005 ) and 38 % ( p = 0.007 ) , respectively . The pain score improved by 40 % ( p = 0.04 ) and the UDI-6 score by 26 % ( p = 0.05 ) . On average , patients reported a 42 % improvement in their symptoms . SF-36 scores did not improve significantly . In refractory patients , bilateral caudal epidural sacral neuromodulation is another possible mode of treatment , which appears to improve both pelvic pain and voiding symptoms To report a multicentre , community based open‐label study design ed to assess the efficacy and safety of intravesical sodium chondroitin sulphate in the treatment of patients with the clinical diagnosis of interstitial cystitis ( IC ) .  Chondroitin sulphate is a naturally occurring glycosaminoglycan ( GAG ) in the bladder mucus layer and changes in this GAG have been implicated in the pathogenesis of IC , and small single‐centre studies have suggested that intravesical chondroitin sulphate may have efficacy in IC Objectives : The aim of this study was to verify the efficacy and safety of intravesical treatment combining sodium hyaluronate ( HA ) and chondroitin sulfate ( CS ) in patients with interstitial cystitis/bladder pain syndrome ( IC/BPS ) . Methods : Between February 2010 and May 2011 , 20 consecutive women with IC/BPS were treated with intravesical instillations containing sodium HA ( 1.6 % ; 800 mg/50 ml ) and sodium CS ( 2 % ; 1 g/50 ml ) weekly for the first month , biweekly for the second month , and then monthly for at least 3 months . Before and after treatment , all patients filled in the Interstitial Cystitis Symptom Index and Problem Index ( ICSI/ICPI ) , the Patient Health Question naire 9 and the Pelvic Pain and Urgency/Frequency Patient Symptom Scale ( PUF ) . Treatment efficacy was assessed by comparing the pre- and post-treatment mean scores of the three question naires using Student ’s t test ( p value < 0.05 was considered significant ) . Results : Statistically significant mean decreases in ICSI ( from 13.0 to 9.3 ; p = 0.0003 ) , ICPI ( from 11.35 to 8.85 ; p = 0.0078 ) and PUF ( from 20.0 to 15.75 ; p = 0.0007 ) question naire scores were seen . No cases of side effects or complications were observed . The mean follow up was 5 months . Conclusions : Despite the limitations of this study , the outcomes confirmed the role of combination therapy with HA and CS as a safe and effective option for the treatment of IC/BPS . Further r and omized controlled studies with a higher number of patients and a longer follow-up period are needed to confirm these results To assess the immediate and sustained relief of the symptoms of interstitial cystitis/painful bladder syndrome ( IC/PBlS ) after a consecutive 5‐day course of treatment with intravesical alkalinized lidocaine ( PSD597 ) , and to characterize the pharmacokinetics of single and multiple doses of intravesical PSD597 in a subgroup of patients OBJECTIVES To present clinical evidence with botulinum toxin A ( BTX-A ) suggesting an antinociceptive role in patients with interstitial cystitis ( IC ) . Intriguing evidence in a somatic pain model has suggested that BTX-A injection may have an antinociceptive effect on both acute and chronic ( inflammatory ) pain . METHODS Thirteen female patients ( 6 in the United States and 7 in Pol and ) with IC according to the criteria of the National Institute of Diabetes , Digestive and Kidney Disease were included . Under short general anesthesia or sedation , 100 to 200 U of Dysport ( Polish patients ) or Botox ( U.S. patients ) was injected through a cystoscope into 20 to 30 sites submucosally in the trigone and floor of the bladder . Patients were evaluated with the O'Leary-Sant vali date d IC question naire or with voiding charts and a visual analog pain scale 1 month postoperatively and at subsequent 3-month intervals . The Polish patients also underwent pretreatment and post-treatment urodynamic evaluations . RESULTS Overall , 9 ( 69 % ) of 13 patients noted subjective improvement after BTX-A treatment . The Interstitial Cystitis Symptom Index and Interstitial Cystitis Problem Index mean scores improved by 71 % and 69 % , respectively ( P < 0.05 ) . Daytime frequency , nocturia , and pain by visual analog scale decreased by 44 % , 45 % , and 79 % , respectively ( P < 0.01 ) . The first desire to void and maximal cystometric capacity increased by 58 % and 57 % , respectively ( P < 0.01 ) . CONCLUSIONS Our results suggest that BTX-A has an antinociceptive effect on bladder afferent pathways in patients with IC , producing both symptomatic and functional ( ie , urodynamic ) improvements OBJECTIVES On the assumption that interstitial cystitis ( IC ) is the result of a defective mucous lining of the bladder epithelium , a study was carried out to investigate the activity of hyaluronic acid ( HA ) in the treatment of IC . HA is an important glycosaminoglycan ( GAG ) present in all connective tissues , including the GAG layer of the vesical mucosa . It exhibits a variety of pharmacologic properties that enhance its appeal for the therapy of IC . METHODS A total of 25 patients , with the characteristic picture of IC and refractory to other medical treatments , participated in a trial of  HA .  Patients received 40 mg of HA intravesically on a weekly basis for 4 weeks , then monthly . Response to therapy was evaluated by symptom score , voiding diaries , and visual analog scales . RESULTS An initial positive ( complete+partial ) response of 56 % at week 4 increased to 71 % by week 12 . This response was maintained until week 20 ; beyond week 24 there appears to be a moderate decrease in the effectiveness of the medication . There was no significant toxicity attributable to the presence of HA in the bladder . CONCLUSIONS The response of refractory IC patients to the intravesical administration of HA was gratifying . In the past , many therapies for IC that were initially considered promising failed the test of a controlled study . Further studies will establish the effectiveness of this particular preparation of HA in the treatment of IC Introduction and hypothesisIntravesical instillations of hyaluronic acid ( HA ) and chondroitin sulfate ( CS ) may lead to regeneration of the damaged glycosaminoglycan layer in interstitial cystitis/bladder pain syndrome ( IC/BPS ) . Methods Twenty-two patients with IC/BPS received intravesical instillations ( 40 ml ) of sodium HA 1.6 % and CS 2.0 % in 0.9 % saline solution ( IALURIL ® , IBSA ) once weekly for 8 weeks , then once every 2 weeks for the next 6 months . Results The score for urgency was reduced from 6.5 to 3.6 ( p = 0.0001 ) , with a reduction in pain scores from an average of 5.6 to 3.2 ( p = 0.0001 ) . The average urine volume increased from 129.7 to 162 ml ( p < 0.0001 ) , with a reduction in the number of voids in 24 h , from 14 to 11.6 ( p < 0.0001 ) . The IC Symptom and Problem Index decreased from 25.7 to 20.3 ( p < 0.0001 ) , and the Pain Urgency Frequency score , from 18.7 to 12.8 ( p < 0.0001 ) . Conclusion The treatment appeared to be effective and well tolerated in IC/BPS in this initial experience PURPOSE Interstitial cystitis ( IC ) is a debilitating condition which causes irritative bladder symptoms , pain and a decrease in health status . The pathophysiology is poorly understood so therapeutic options are diverse . Percutaneous posterior tibial nerve stimulation is an effective treatment and pulsed transdermal laser stimulation is an established technique for pain management . We evaluated the efficacy of transdermal laser stimulation of the posterior tibial nerve for patients with IC . MATERIAL S AND METHODS Women meeting the National Institutes of Health National Institute for Diabetes and Digestive and Kidney Diseases criteria for IC were prospect ively recruited and r and omized to treatment ( 29 ) or placebo ( 27 ) cohorts in a double-blind trial . At home the patient performed laser therapy daily for 30 seconds over the SP6 acupuncture point for 12 weeks . Measures at baseline and at 84-day followup included the 7-day voiding diary , the Interstitial Cystitis Problem Index , Interstitial Cystitis Symptom Index and R AND 36-Item Health Survey question naires . RESULTS There were no significant differences between the treatment and control cohorts on any of the measures . However , there was a significant decrease between baseline and 12-week followup in the amount voided , symptom problems and severity , and on all 8 SF-36 scales . There was no significant effect of fluid intake . CONCLUSIONS This study demonstrated no difference between the active and sham device . However , it is interesting that treatment and control cohorts experienced similar improvements , suggesting that the control cohort improvements may have been due to participants ' belief that they were receiving active treatment from the stimulator . These findings provide support for investigating placebo effects in r and omized trials AIMS Interstitial cystitis/bladder pain syndrome ( IC/BPS ) is a prevalent disorder that may contribute to bladder cancer ( BC ) . This cohort study set out to investigate the association between IC/BPS and BC by using a population -based data set . METHODS The data for this study were source d from the Taiwan National Health Insurance program . The case cohort comprised 7,562 patients with IC/BPS , and 22,686 r and omly selected subjects were used as a comparison cohort . A Cox proportional hazards regression model ( stratified by age group , geographic location , urbanization level , and the index year ) was constructed to estimate the risk of subsequent BC following a diagnosis of IC/BPS . We also ran the analysis utilizing an alternative comparison cohort composed of patients with urinary incontinence ( UI ) . RESULTS In the study sample of 30,248 patients , 96 patients ( 0.32 % ) received a diagnosis of BC during the 3-year follow-up period ; 48 ( 0.63 % of patients with IC/BPS ) were from the study cohort ; and 48 ( 0.21 % of patients without IC/BPS ) were from the comparison cohort . The incidence rate of BC was 2.12 ( 95 % CI : 1.58 - 2.78 ) per 1,000 person-years in patients with IC/BPS and 0.70 ( 95 % CI : 0.52 - 0.92 ) per 1,000 person-years in comparison patients . Cox proportional analysis revealed that the adjusted HR for BC during the 3-year follow-up period for patients with IC/BPS was 2.95 ( 95 % CI : 1.97 - 4.41 ) that of comparison subjects . When performing the analysis with the alternative UI comparison cohort , the adjusted HR for BC was 1.96 ( 95 % CI : 1.14 - 3.39 ) . CONCLUSIONS This investigation detected a novel association between BC and prior IC/BPS Background : Current medications used in the treatment of interstitial cystitis ( IC ) have limited efficacy . This prospect i ve study investigated the efficacy of multiple intravesical instillations of resiniferatoxin ( RTX ) at the concentration of 10 nM. Methods : Patients with proven IC previously treated with traditional medications for more than 6 months without clinical benefit were enrolled . They were excluded if bladder outlet obstruction or urinary tract infection was present .  Intravesical instillation of low-dose RTX ( 10 nM ) once weekly for 4 weeks was performed at the outpatient department . International Prostate Symptom Score ( IPSS ) , 5-Point Pain Scale , and Quality of Life Index ( QOL Index ) were recorded . A videourodynamic study was done at baseline and 3 months after treatment . Results : The therapeutic results and urodynamic parameters were compared between baseline and 3 months . Thirteen patients , including 10 women and 3 men , were enrolled in this study . The mean duration of IC  symptoms was 4.4 ± 2.5 years . The mean duration of active treatment was 15.3 ± 8.6 months . One female patient dropped out due to severe bladder pain after RTX instillation . Among the 12 patients who completed the study treatment , subjective assessment revealed that 2 had an excellent therapeutic result , 5 had an improved result and 5 remained unchanged from baseline . The overall satisfactory rate was 58.3 % . IPSS , 5-Point Pain Scale , and QOL Index were significantly decreased after RTX treatment . There was no significant increase in mean functional bladder capacity or change in urodynamic parameters . No serious adverse event occurred after RTX treatment . Conclusions : This study suggests that multiple intravesical instillations of RTX at the concentration of 10 nM are effective in relieving lower urinary tract symptoms in patients with refractory IC . The treatment is tolerable and suitable for use on an outpatient clinic basis Purpose Bladder pain syndrome is a chronic disease that manifests as bladder pain , frequency , nocturia , and urgency . Gabapentin , amitriptyline , and nonsteroidal anti-inflammatory drugs are efficacious treatments for bladder pain syndrome . Here , we assessed the effect of triple therapy with these drugs in women with bladder pain syndrome . Methods Between May 2007 and May 2010 , we conducted a prospect i ve nonr and omized study on 74 patients with bladder pain syndrome . Of these patients , 38 ( 11 men and 27 women ; mean age , 55.9 years ; range , 25 to 77 years ; mean follow-up , 12.6 months ) were administered the interstitial cystitis ( IC ) symptom scales ( O'Leary-Sant Symptom Index ) and visual analog scale ( VAS ) 1 , 3 , and 6 months after treatment to assess the efficacy of triple therapy . Results The pretreatment O'Leary-Sant IC symptom score was 11.7 , and the post-treatment scores were 4.4 , 3.8 , and 4.0 at 1 , 3 , and 6 months , respectively ; the pretreatment problem index score was 10.5 , and the post-treatment scores were 3.7 , 2.7 , and 2.9 at 1 , 3 , and 6 months , respectively . The pretreatment VAS score was 6.7 , and the post-treatment scores were 1.8 , 1.5 , and 1.7 at 1 , 3 , and 6 months , respectively . The O'Leary-Sant IC symptom index and problem index and VAS scores improved considerably 1 month after treatment ( P<0.05 ) . However , the results at 1 , 3 , and 6 months after treatment were not significantly different ( P>0.05 ) . Conclusions Triple therapy was sufficiently effective in patients with bladder pain syndrome and caused no significant adverse effects . However , large-scale studies should be performed to verify our findings PURPOSE Increased urothelial permeability has been proposed as a cause of interstitial cystitis ( IC ) . The potassium sensitivity test assesses bladder discomfort after instillation of 0.4 M KCl for identification of increased urothelial permeability . Since exposure to 0.4 M KCl may be extremely painful for patients with IC we investigated a less traumatic alternative . MATERIAL S AND METHODS The study comprised 38 controls and 40 patients with IC . In all subjects cystometry was performed with 0.9 % NaCl followed by 0.2 M KCl , and filling volume at first urge and maximum bladder capacity ( Cmax ) were assessed for both solutions . RESULTS Controls did not show a significant change in Cmax . KCl decreased Cmax in 37 of 40 ( 92 % ) patients with IC with a mean decrease of 30 % . The examination was painless in all controls and in 33 of 40 ( 82 % ) patients with IC , and was moderately painful in 7 . CONCLUSIONS For demonstration of increased potassium sensitivity and diagnosis of IC , comparative assessment of Cmax is a well tolerated alternative to the 0.4 M potassium sensitivity test . Statistical evaluation of these results suggests that a decrease in Cmax greater than 30 % is indicative of IC To provide evidence for the clinical efficacy of changes in urinary pH on the pain associated with interstitial cystitis ( IC ) PURPOSE Interstitial cystitis ( IC ) is a disorder of unknown etiology with few effective therapies . Oral bioflavonoid therapy utilizing quercetin recently proved to be clinical ly effective in men with chronic pelvic pain syndrome , a disorder with similarities to IC . We therefore tested in an open-label trial a quercetin-based supplement in patients with clinical ly proven IC . MATERIAL S AND METHODS Twenty-two patients ( 5 men and 17 women ; average age 53.1 years ) with classically documented IC received  one capsule of Cysta-Q complex ( equivalent to 500 mg of quercetin ) twice a day for 4 weeks . Symptoms were assessed before and after therapy by the IC problem and symptom indices as well as by global assessment of pain ( range 0 - 10 ) . RESULTS Two patients did not complete the study . In the remaining 20 patients , improvement was seen in all three parameters tested . After 4 weeks of treatment , the mean ( + /- SEM ) problem index improved from 11.3 + /- 0.6 to 5.1 + /- 0.7 ( p = .000001 ) , the mean symptom index improved from 11.9 + /- 0.9 to 4.5 + /- 0.5 ( p = .000001 ) , and the mean global assessment score improved from 8.2 + /- 0.4 to 3.5 + /- 0.4 ( p = .000001 ) . None of the patients experienced any negative side effects , and all but one patient had at least some improvement in every outcome measure . CONCLUSION Oral therapy with the quercetin supplement Cysta-Q was well tolerated and provided significant symptomatic improvement in patients with IC . Larger , r and omized , placebo-controlled trials appear warranted based on these preliminary open-label results PURPOSE This pilot study was design ed to evaluate the feasibility of a multicenter , r and omized , clinical trial in interstitial cystitis ( IC ) . Secondary objectives were to evaluate the safety and efficacy of oral pentosan polysulfate sodium ( PPS ) , hydroxyzine , and the combination to consider their use in a larger r and omized clinical trial . MATERIAL S AND METHODS A 2 x 2 factorial study design was used to evaluate PPS and hydroxyzine .  Participants met the National Institutes of Health-National Institute for Diabetes and Digestive and Kidney Diseases criteria for IC and reported at least moderate pain and frequency for a minimum of 6 months before study entry . The primary end point was a patient reported global response assessment . Secondary end points included vali date d symptom indexes and patient reports of pain , urgency and frequency . The target sample size was 136 participants recruited during 10 months . RESULTS A total of 121 ( 89 % of goal ) participants were r and omized over 18 months and 79 % provided complete followup data . The response rate for hydroxyzine was 31 % for those treated and 20 % for those not treated ( p = 0.26 ) . A nonsignificant trend was seen in the PPS treatment groups ( 34 % ) as compared to no PPS ( 18 % , p = 0.064 ) . There were no treatment differences for any of the secondary end points . Adverse events were mostly minor and similar to those in previous reports . CONCLUSIONS The low global response rates for PPS and hydroxyzine suggest that neither provided benefit for the majority of patients with IC . This trial demonstrated the feasibility of conducting a multicenter r and omized clinical trial in IC using uniform procedures and outcomes . However , slow recruitment underscored the difficulties of evaluating commonly available IC drugs
Current evidence also suggests the efficacy of  dimethyl sulfoxide and amitryptyline therapy .
Hydroxyzine , intravesical bacille Calmette-Guérin  , and  resiniferatoxin therapy  failed to demonstrate efficacy , but evidence was inconclusive owing to method ological limitations .
Pentosan polysulfate may be modestly beneficial for symptoms of PBS/IC .
There is insufficient evidence for other pharmacologic treatments .
BACKGROUND More than 180 different types of therapy have been used in the treatment and management of  painful bladder syndrome/interstitial cystitis ( PBS/IC ) , yet evidence from clinical trials remains inconclusive .
This study aim ed to evaluate the efficacy of pharmacologic approaches to PBS/IC , to quantify the effect size from r and omized controlled trials , and to begin to inform a clinical consensus of treatment efficacy for PBS/IC .