Measuring the success of combined intravesical dimethyl sulfoxide and triamcinolone for treatment of bladder pain syndrome/interstitial cystitis.
OBJECTIVE
The purpose of this study was to investigate change in bladder capacity as a measure of response to combined intravesical dimethyl sulfoxide (DMSO) and triamcinolone instillations for the treatment of newly diagnosed bladder pain syndrome/interstitial cystitis (BPS/IC).


METHODS
141 newly diagnosed women were identified retrospectively. 79 were treated with weekly DMSO/triamcinolone instillations. Change in bladder capacity with bladder retrofill, daytime urinary frequency, nocturia episodes per night, and Likert scale symptom scores were reviewed. Wilcoxon signed-rank tests, Wilcoxon rank-sum tests, Spearman's rank correlations, COX regression analysis, and a Kaplan-Meier survival curve were performed.


RESULTS
Significant changes (median (25(th)-percentile to 75(th)-percentile) were noted for bladder capacity (75 mL (25 to 130 mL), p < 0.0001), inter-void interval (0 hrs (0 to 1 hour), p < 0.0001), nocturia episodes per night (-1 (-2 to 0), p < 0.0001), and aggregate Likert symptom scores (-2 points (-5 to 0), p < 0.0001). Percent change in bladder capacity correlated positively with percent change in inter-void interval (p = 0.03) and negatively with percent changes in nocturia (p = 0.17) and symptom scores (p = 0.01). Women without detrusor overactivity (DO) had greater percent changes in capacity than women with DO (62.5 % vs. 16.5 %, p = 0.02). 61.3 % of patients were retreated with a 36 weeks median time to retreatment and no difference in time to retreatment based upon DO. Greater capacity was protective against retreatment (hazard ratio = 0.997 [95 % CI 0.994,0.999], p = 0.02).


CONCLUSIONS
Percent change in bladder capacity is a useful objective measure of response to intravesical DMSO/triamcinolone for newly diagnosed BPS/IC. Clinical outcomes do not differ based upon presence of DO.
Evanston Continence Center, Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, NorthShore University HealthSystem, University of Chicago, Pritzker School of Medicine, 1000 Central Street #730, Evanston, IL 60201, USA. agafni-kane@northshore.org
Adam
A
Gafni-Kane
Sylvia M
SM
Botros
Hongyan
H
Du
Robert I
RI
Sand
Peter K
PK
Sand
D000283:Administration, Intravesical; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D018856:Cystitis, Interstitial / Q000188:drug therapy* / Q000503:physiopathology; D004121:Dimethyl Sulfoxide / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000503:physiopathology; D012189:Retrospective Studies; D013577:Syndrome; D016896:Treatment Outcome; D014221:Triamcinolone / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D001743:Urinary Bladder / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology; D001745:Urinary Bladder Diseases / Q000188:drug therapy* / Q000503:physiopathology; D014554:Urination / Q000187:drug effects / Q000502:physiology
D000893:Anti-Inflammatory Agents; D014221:Triamcinolone; D004121:Dimethyl Sulfoxide