Table 5. Treatment of Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS).
| Category | Examples | Evidence strengtha | Comments |
|---|---|---|---|
| Oral pharmacotherapy | |||
| Analgesics | NSAIDs | Expert opinion | Consider multimodality therapy. Avoid opioids |
| Restore epithelial barrier | Pentosan polysulfate sodium (PPS) | B102 | Restores epithelial permeability barrier Only oral therapy approved by the FDA |
| Mast cell stabilizers | Hydroxyzine | C103 | Main adverse effect: sedation |
| Cimetidine | B104 | Potential for drug interactions | |
| Neuromodulators | Amitriptyline | B105 | May be used in combination with PPS, hydroxyzine 106 |
| Immunosuppressants | Cyclosporine A | C107 | Reserve for refractory IC/BPS Potential for serious adverse effects |
| Intravesicular therapy | |||
| Free-radical scavenger | Dimethyl sulfoxide | C108 | Only intravesicular therapy approved by the FDA May be administered as a cocktail with heparin, sodium bicarbonate, lidocaine, and corticosteroids5 |
| Restore bladder barrier | Heparin | C109 | Infrequent and minor adverse effects in noncontrolled studies |
| Topical anesthetics | Lidocaine | C110 | Combination with sodium bicarbonate avoids ionization within urine, thereby increasing ability to penetrate uroepithelium |
| Hydrodistention of bladder | Low pressure and short duration | C111 | Generally performed with low pressure (60 to 80 cm H2O) and for a short duration (<10 min) |
| Bladder fulguration | Laser, electrocautery | C112 | Considered for Hunner ulcers |
| Botulinum toxin type A (BoNT-A) | Intradetrusor BoNT-A injection | B113 | BoNT-A 100 U and 200 U provided comparable relief, but urinary retention was more common after 200 U114 |
| Surgery | |||
| Sacral nerve stimulation | Sacral neuromodulation (InterStim™; Medtronic) | C115 | More effective for urinary symptoms than pain |
| Bladder surgery | Substitution cystoplasty Urinary diversion with/without cystectomy |
C116 | Last resort Patients should be informed that pain may persist after surgery |
Abbreviations: FDA, US Food and Drug Administration; IC/BPS, interstitial cystitis/bladder pain syndrome; NSAID, nonsteroidal antiinflammatory drug; SNRI, serotonin-norepinephrine reuptake inhibitor.
a
Level A: meta-analysis of well-designed randomized controlled trials; B: at least 1 well-designed randomized controlled trial; C: at least 1 well-designed observational study; D: case series.