Intravesical treatment for interstitial cystitis/painful bladder syndrome: a network meta-analysis.
OBJECTIVE
Interstitial cystitis/painful bladder syndrome (IC/PBS) is a chronic inflammatory condition of the submucosal and muscular layers of the bladder. So far, there is no effective and targeted treatment strategy for IC/PBS. This study aimed to assess the efficacy and safety of intravesical instillation treatment in IC/PBS patients.


METHODS
We searched various databases up to October 2015. A network meta-analysis was performed to compare global response assessment (GRA) for different treatment strategies, including botulinum toxin A (BoNTA), bacillus Calmette-Guerin (BCG), resiniferatoxin (RTX), lidocaine, chondroitin sulfate (CS), oxybutynin, and pentosan polysulfate (PPS). A traditional meta-analysis was also performed.


RESULTS
Sixteen trials evaluating 905 patients were included. Network meta-analysis indicated that BoNTA had the highest probability of being the best treatment course according to GRA assessment results (probability 81.7 %). BCG or BoNTA therapy yielded significant improvement in GRA incidence according to traditional meta-analysis. Patients who received PPS showed higher urinary frequency results compared with the placebo groups. BCG- and PPS-treated patients had elevated urinary urgency treatment effects compared with placebo groups. Bladder capacity restoration results also showed significant improvements in patients who received BoNTA compared with placebo-treated individuals.


CONCLUSIONS
These findings indicate that BoNTA therapy has the highest probability of being the best therapy according to GRA, and significantly improves bladder capacity in IC/PBS patients. BCG treatment also significantly increases the incidence of GRA and improves the symptoms of urinary urgency. PPS can significantly improve urinary frequency and urgency symptoms in IC/PBS patients.
Tianjin Institute of Urology, The 2nd Hospital of Tianjin Medical University, Tianjin Medical University, 23 Pingjiang Road, Hexi District, Tianjin, 300211, People's Republic of China.
Wei
W
Zhang
Tianjin Institute of Urology, The 2nd Hospital of Tianjin Medical University, Tianjin Medical University, 23 Pingjiang Road, Hexi District, Tianjin, 300211, People's Republic of China.
Xiaojing
X
Deng
Tianjin Institute of Urology, The 2nd Hospital of Tianjin Medical University, Tianjin Medical University, 23 Pingjiang Road, Hexi District, Tianjin, 300211, People's Republic of China.
Chunyu
C
Liu
Tianjin Institute of Urology, The 2nd Hospital of Tianjin Medical University, Tianjin Medical University, 23 Pingjiang Road, Hexi District, Tianjin, 300211, People's Republic of China. xuwang2003@sina.com.
Xu
X
Wang
D000283:Administration, Intravesical; D001500:BCG Vaccine / Q000008:administration & dosage*; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D018856:Cystitis, Interstitial / Q000188:drug therapy*; D006801:Humans; D009498:Neurotoxins / Q000008:administration & dosage*
D001500:BCG Vaccine; D009498:Neurotoxins; D019274:Botulinum Toxins, Type A
Clinical trials; Interstitial cystitis; Intravesical treatment; Meta-analysis; Painful bladder syndrome