title: Long-term outcomes of intravesical dimethyl sulfoxide/heparin/hydrocortisone therapy for interstitial cystitis/bladder pain syndrome.
abstract: OBJECTIVE
  For decades, intravesical dimethyl sulfoxide (DMSO) cocktail therapy has been used for the treatment of interstitial cystitis/bladder pain syndrome (IC/BPS), but little is known about its long-term efficacy. We aimed to assess the long-term efficacy of intravesical DMSO/heparin/hydrocortisone/bupivacaine therapy in patients with IC/BPS.
  
  
  METHODS
  Patients with IC/BPS from our institutions who underwent this therapy with >2 years follow-up were surveyed with O'Leary-Sant interstitial cystitis symptom and problem index questionnaires before and after therapy. Chart reviews and telephone surveys were then conducted to determine their posttherapy course.
  
  
  RESULTS
  Of 68 eligible women, 55 (80.0%) with a median follow-up of 60 months (range 24-142) were surveyed. Their mean age at therapy onset was 44.8 years and their mean body mass index was 26.2 kg/m2. There were statistically significant improvements in O'Leary-Sant and pain scores of 23-47% at both 6 weeks and the end of the follow-up period. At the end of the follow-up period, 19 of the 55 women (34.5%) were cured (requiring no further treatment) and 12 (21.8%) were significantly improved (requiring only ongoing oral medication). Univariate and multivariate analyses showed that DMSO treatment failure was more likely in patients with pretreatment day-time urinary frequency more than 15 episodes per day (OR 1.41), nocturia more than two episodes per night (OR 2.47), maximum bladder diary voided volume <200 ml (OR 1.39) and bladder capacity under anaesthesia <500 ml (OR 1.6).
  
  
  CONCLUSIONS
  At a median follow-up of 60 months, intravesical DMSO cocktail therapy appeared moderately effective for the treatment of IC/BPS. Treatment failure was more frequent in patients with pretreatment symptoms of reduced bladder capacity.
authors.affiliation: Department of Urogynaecology, Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC, 3084, Australia. yik_lim@yahoo.com.au.
authors.forename: Yik N
authors.initials: YN
authors.lastname: Lim
authors.affiliation: Department of Urogynaecology, Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC, 3084, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Dwyer
authors.affiliation: Department of Urogynaecology, Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC, 3084, Australia.
authors.forename: Christine
authors.initials: C
authors.lastname: Murray
authors.affiliation: Department of Urogynaecology, Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC, 3084, Australia.
authors.forename: Debjyoti
authors.initials: D
authors.lastname: Karmakar
authors.affiliation: Monash Medical Centre, Melbourne, VIC, Australia.
authors.forename: Anna
authors.initials: A
authors.lastname: Rosamilia
authors.affiliation: Department of Urogynaecology, Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC, 3084, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Thomas
mesh_terms: D000283:Administration, Intravesical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D000925:Anticoagulants / Q000008:administration & dosage; D003451:Cryoprotective Agents / Q000008:administration & dosage*; D018856:Cystitis, Interstitial / Q000188:drug therapy*; D004121:Dimethyl Sulfoxide / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage; D008875:Middle Aged
chemical_list: D000893:Anti-Inflammatory Agents; D000925:Anticoagulants; D003451:Cryoprotective Agents; D006493:Heparin; D006854:Hydrocortisone; D004121:Dimethyl Sulfoxide
keywords: Bladder pain syndrome; Interstitial cystitis; Intravesical DMSO therapy; Long-term outcome