Therapeutic options in the management of interstitial cystitis

Abstract

There are many uncertainties about the symptom complex which comprises urinary frequency, urgency and pain, and in the absence of any other cause is defined as interstitial cystitis (IC). The name itself is controversial. Should it be known as painful bladder, irritable bladder, chronic pelvic pain of the bladder or part of chronic pelvic pain syndrome? It is difficult to obtain a consensus view where to date there is no specific clinical sign, serum or urine marker, or tissue diagnosis. At the same time, the options available for the treatment of interstitial cystitis are continuing to increase. General and supportive measures are of great importance as is education and information through the support group network. Oral therapies such as amitriptyline, elmiron, hydroxyzine and analgesics including nonsteroidal anti-inflammatories can be useful. Intravesical dimethyl sulfoxide (DMSO) and/or heparin have proven efficacy. Sacral neuromodulation is an exciting development for those not responsive to conservative therapy; the surgical techniques continue to evolve and long-term evaluation is awaited. Major urologic surgery is occasionally required for a small percentage of IC patients. The evaluation of efficacy of treatments for IC is difficult because of factors such as the natural history of the condition with its flares and remissions, and the known placebo effect of 30%. Nonetheless, this is an important exercise which is currently underway and the results of the randomized controlled trials are eagerly awaited.