Multimodal therapy for painful bladder syndrome / interstitial cystitis: pilot study combining behavioral, pharmacologic, and endoscopic therapies.
OBJECTIVE
We evaluated the effectiveness of combining behavioral therapy, pharmacologic therapy and endoscopic hydrodistension for treating painful bladder syndrome / interstitial cystitis (PBS/IC).


METHODS
Twenty-five patients with PBS/IC were prospectively enrolled in a pilot multimodal behavioral, pharmacologic and endoscopic treatment protocol. Behavioral modification included diet recommendations, fluid restriction to 64 oz. /day, progressive timed voiding and Kegel exercises. Oral pharmacologic therapy consisted of daily doses of macrodantin 100 mg, hydroxyzine 10-20 mg and urised 4 tablets. Patients underwent endoscopic bladder hydrodistention under anesthesia at least 2 weeks after protocol enrollment. Behavioral and pharmacological treatments were continued after the hydrodistention. O'Leary-Sant questionnaire scores were recorded before starting the protocol, after pharmacologic/behavioral therapy, 2 months post-hydrodistension, and at scheduled follow-up.


RESULTS
Eighteen patients (72%) completed the pilot multimodal treatment protocol and were followed for a mean of 10.2 months. All patients were female with a median age of 36.3 years and had mean bladder capacity under anesthesia of 836 milliliters. Mean O'Leary-Sant symptom index scores for baseline symptoms, after behavioral/pharmacologic treatment, post-hydrodistension and during follow up were 12.5, 8.6, 7.0, and 6.7 (p < 0.05). Mean O'Leary-Sant problem index scores for baseline, after behavioral/pharmacologic treatment, post-hydrodistention and during follow up were 12.7, 8.9, 6.7, and 7.7 (p < 0.05).


CONCLUSIONS
Our pilot multimodal protocol of behavioral modification, pharmacologic therapy and endoscopic hydrodistention demonstrated a significant progressive improvement in PBS/IC quality of life scores, compared to a pre-treatment baseline. These results should be validated in a larger, placebo controlled trial.
Hanley
Robert S
RS
Anne Arundel Urology, Annapolis, Maryland, USA.
Stoffel
John T
JT
Zagha
Ralph M
RM
Mourtzinos
Arthur
A
Bresette
John F
JF
D000328:Adult; D000892:Anti-Infective Agents, Urinary; D001521:Behavior Therapy / Q000379:methods; D003131:Combined Modality Therapy / Q000379:methods; D018856:Cystitis, Interstitial / Q000628:therapy*; D004106:Dilatation / Q000379:methods; D004724:Endoscopy; D005260:Female; D006801:Humans; D006919:Hydroxyzine / Q000627:therapeutic use; D009582:Nitrofurantoin / Q000627:therapeutic use; D010865:Pilot Projects; D011446:Prospective Studies; D016896:Treatment Outcome
D000892:Anti-Infective Agents, Urinary; D006919:Hydroxyzine; D009582:Nitrofurantoin