From the Guidelines
Interstitial Cystitis (IC) is Not Curable
Interstitial cystitis (IC) is a chronic condition characterized by recurring discomfort or pain in the bladder and surrounding pelvic region. While there is no known cure for IC, various treatment options are available to manage symptoms, including oral medications such as pentosan polysulfate (100-200 mg three times daily) and amitriptyline (10-50 mg daily), as well as intravesical instillations of dimethyl sulfoxide (50% solution, 10-15 mL, administered weekly for 6-8 weeks) 1.
- Treatment Approaches: These treatments can help alleviate symptoms in some patients, but individual responses may vary and ongoing management is often necessary to control the condition 1.
- Guideline Recommendations: The American Urological Association (AUA) guidelines recommend a multimodal approach to treatment, including behavioral modifications, oral medications, and intravesical instillations, with the goal of maximizing symptom control and patient quality of life while minimizing adverse events and patient burden 1.
- Clinical Strategy: The most effective approach for a particular patient is best determined by the clinician together with the patient, taking into account the individual's unique characteristics and needs 1.
- Ongoing Management: As the science relevant to IC/BPS evolves and improves, treatment strategies will require amendment to remain consistent with the highest standards of clinical care.
From the Research
Treatment Options for Interstitial Cystitis (IC)
- The management of IC is challenging, and there are currently no universally effective therapies available 2.
- Treatment options include oral medications, intravesical instillations, and surgical interventions, which can provide varying degrees of symptom relief 2, 3, 4.
- A comprehensive approach to diagnosis and management is recommended, including symptom-based techniques, pharmacologic agents, and patient education 3.
Effectiveness of Treatment Options
- Intravesical treatments, such as Resiniferatoxin, Dimethyl sulfoxide, BCG, pentosanpolysulphate, oxybutin, and alkalinisation of urine pH, have shown limited evidence of effectiveness, with wide confidence intervals and mixed quality of trial reports 4.
- BCG and oxybutin are reasonably well-tolerated and have shown promising results, while Resiniferatoxin has shown no evidence of effect and caused pain, reducing treatment compliance 4.
- Oral medications, such as nonsteroidal anti-inflammatory drugs, tricyclic antidepressants, gabapentin, and pentosan polysulfate, have also shown varying degrees of efficacy 2.
Current Understanding and Future Directions
- The pathophysiology of IC is poorly understood, and the ideal treatment should match the pathophysiologic causes of the disease, but the available evidence limits this approach 5.
- A personalized and progressive approach to treatment is recommended, starting with conservative options and advancing to more invasive and combined treatments 5.
- Further investigation into the etiopathogenetic mechanisms and the interaction between central and peripheral factors is needed to improve treatment and management of IC 5.