| Interstital Cystitis | |
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Introduction >> |
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Symptoms >> |
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Etiology >> |
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Diagnosis >> |
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Epidemiology >> |
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General Management >> |
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Treatment >> |
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Medications >> |
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Direct Bladder Therapy >> |
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Surgical Treatments >> |
DIRECT BLADDER THERAPY
Cystoscopy under anesthesia hydro distention of the bladder has been utilized in management of IC symptoms since the 1940s. In this procedure, frequently done in an operating room setting, the bladder is distended with the infusion bag being situated approximately 80 cm above the symphysis pubis. The fluid is run into the bladder under gravity until the intravesical pressure stops it spontaneously. The bladder is then maintained distended for three to five minutes and once it is drained, a second look is recommended to observe for the appearance of “glomerulations” and ulcerations in the bladder lining. Some people repeat the hydro-distention in the same manner and the need for a concomitant bladder biopsy remains controversial, though it has been practiced by many physicians. At Associates in Urology we often perform cystoscopy in the office and under local anesthesia and distend the bladder. Many patients report a clinical response without needing general anesthesia.
The exact reason why IC patients respond to hydrodistention of the bladder is unclear, but at least 50 to 75 % of the patients report dramatic improvement, though it may take up to three or four weeks before it becomes noticeable.
DMSO- The instillation of DMSO (dimethyl sulfoxide) into the bladder was approved by the FDA for the treatment of IC in 1978. The DMSO is instilled via a catheter into the bladder once a week for six to eight treatments. With each treatment the patient attempts to hold it within the bladder for between 15 to 30 minutes. We alert the patient that following the first two or three treatments their IC symptoms may be exacerbated before they will notice an improvement. A body odor and taste of garlic is a common side effect that can last for four to six hours following each treatment. In addition, many patients experience significant discomfort and even temporary pain while they retain the DMSO in their bladders. For that reason the DMSO can be mixed with heparin, local anesthetics and bicarbonate (the so called cocktail DMSO) to alleviate the discomfort that is associated with this treatment.
Investigational (? Future) therapy- Other intravesical agents for the treatment of IC were investigated in the past. These included TICE BCG (bacillus Calmette-Guerin) and Cystistat (hyaluronic acid). Reports of the efficacy of both modalities have been inconclusive and at best mixed and long term results are awaiting the completion of multi-center clinical trials.
Recent sporadic reports on treating IC patients with bladder injections of BOTOX (Botulinum type A) began to surface. This treatment, in our experience, has very promising outcomes in patients with intractable symptoms of overactive bladder (OAB) and we anticipate future research in treating IC patients with BOTOX.
Updated June 23rd, 2007