What is the efficacy of intravesical triamcinolone (a corticosteroid) injection for the treatment of interstitial cystitis?

From the Guidelines

Bladder triamcinolone injection is a recommended treatment for interstitial cystitis, specifically when Hunner lesions are present, as it can improve clinical symptoms and quality of life. According to the guideline statement from The Journal of Urology 1, fulguration with electrocautery and/or injection of triamcinolone can be used to treat Hunner lesions and improve symptoms such as urinary frequency, urgency, and pain. The evidence suggests that triamcinolone injection, with or without electrocautery, can provide significant improvement in symptoms and quality of life, although symptoms can recur and periodic retreatment may be necessary 1.

Some key points to consider when using triamcinolone injection for interstitial cystitis include:

• The presence of Hunner lesions is a key indicator for the use of triamcinolone injection 1
• The treatment can provide improvement in symptoms and quality of life, but may require periodic retreatment 1
• The use of triamcinolone injection is recommended in conjunction with other treatments, such as fulguration with electrocautery 1
• Patients should be counseled about the potential need for repeat treatments and the potential risks and benefits of the procedure 1

It is essential to note that the evidence supporting the use of triamcinolone injection for interstitial cystitis is based on a guideline statement with a Grade C evidence strength 1, indicating that the recommendation is based on limited evidence, but still considered a viable treatment option for patients with Hunner lesions.

From the Research

Bladder Triamcinolone Injection for Interstitial Cystitis

• The use of triamcinolone acetonide for interstitial cystitis-bladder pain syndrome (IC/BPS) has been studied in various research papers 2, 3.
• A randomized controlled trial published in 2021 found that the addition of triamcinolone acetonide to a standard bladder instillation solution did not improve symptoms associated with IC/BPS 3.
• The trial compared symptom response in women with IC/BPS who underwent six bladder instillations with triamcinolone acetonide or six instillations without, and found no significant difference between the two groups 3.
• Another study published in 2018 discussed the use of triamcinolone as a minimally invasive treatment option for IC/BPS, but did not provide specific results on its efficacy 2.
• The American Urological Association (AUA) recommendations for IC/BPS instillation therapy include dimethyl sulfoxide, heparin, and lidocaine, but do not mention triamcinolone acetonide as an option 4.

Treatment Options for Interstitial Cystitis

• IC/BPS is a challenging condition to diagnose and treat, and various treatment options are available, including oral and intravesical medications, as well as minimally invasive procedures 2, 5.
• Oral therapies for IC/BPS include amitriptyline, hydroxyzine, cyclosporine A, and pentosan polysulfate sodium (PPS), although the use of PPS has been associated with concerns about pigmented maculopathy 5.
• A systematic review of randomized controlled trials found that PPS was efficacious in improving symptoms of IC/BPS, including bladder pain, urinary urgency, and frequency of micturition 6.
• Other treatment options for IC/BPS include immunomodulating drugs, stem cell therapy, nerve growth factor, and ASP6294, although these are still considered novel and emerging treatments 2.