genitourinary disorders
Interstitial Cystitis
Treatment of Interstitial Cystitis
Lifestyle modification Bladder training Medications (eg,pentosanpolysulfate sodium, tricyclic antidepressants, nonsteroidal anti-inflammatory drugs [NSAIDs],dimethyl sulfoxideinstillation) Surgery as a last resort Up to 90% of patients improve with treatment, but cure is rare. Treatment should involve encouraging awareness and avoidance of potential triggers, such as tobacco, alcohol, foods with high potassium content, and spicy foods. In addition to lifestyle modification, bladder training, drugs, intravesical therapies, and surgery are used as needed. Stress reduction and Biofeedback (to strenghten pelvic floor muscles, eg, with Kegel exercises) may help. No treatment has been proved effective, but a combination of The most commonly used oral drug ispentosanpolysulfate sodium ; doses of 100 mg orally 3 times a day may help restore the bladder’s protective surface lining. Improvement may not be noticed for 2 to 4 months. Intravesical instillation of 15 mL of a solution containing 100 mg ofpentosanor 40,000 units ofheparinplus 80 mg oflidocaineand 3 mL ofsodium bicarbonatemay benefit patients who are unresponsive to oral drugs. Tricyclic antidepressants and NSAIDs in standard doses may relieve pain. Antihistamines may help by directly inhibiting mast cells or by blocking allergic triggers. Dimethyl sulfoxideinstilled into the bladder through a catheter and retained for 15 minutes may deplete substance P and trigger mast cell granulation; 50 mL every 1 to 2 weeks for 6 to 8 weeks, repeated as needed, relieves symptoms in up to one half of patients. Intravesical instillation of bacille Calmette-Guérin (BCG) and hyaluronic acid are under study. Bladder hydrodistention, cystoscopic resection of a Hunner ulcer, and sacral nerve root (S3) stimulation help some patients. Surgery (eg, partial cystectomy, bladder augmentation, neobladder reconstruction, and urinary diversion) is a last resort for patients with intolerable pain refractory to all other treatments. Outcome is unpredictable; in some patients, symptoms persist. 