Which bladder instillations are more effective? DMSO vs. bupivacaine/heparin/triamcinolone: a retrospective study.
OBJECTIVE
Bladder pain syndrome/interstitial cystitis (BPS/IC) is a chronic and debilitating condition. Our objective was to compare two different bladder instillation treatments in patients with BPS/IC: dimethyl sulfoxide with triamcinolone (DMSO) vs. bupivacaine with heparin and triamcinolone (B/H/T). Our hypothesis was that both treatments are equally effective.


METHODS
A retrospective cohort study of instillation-naïve patients was conducted comparing responses to either DMSO or B/H/T at our tertiary urogynecology center from 2012 to 2014. The primary outcome was patient-reported percent of overall improvement from baseline. Secondary outcomes were change in patient-reported daytime voiding frequency (hours) and change in number of nighttime voiding episodes. Variables analyzed as potential confounders included pelvic pain, cystoscopy findings, levator spasm, and fibromyalgia. The two-sided Student's t test, chi-squared test, Poisson regression, and repeated-measure analysis of variance (ANOVA) were used for analyses.


RESULTS
One hundred and ninety-three eligible patients were identified (45 receiving DMSO, 146 receiving B/H/T). Compared with baseline, DMSO patients reported 63% improvement (p < 0.0001), increased time between daytime voids by 1.5 h (p < 0.00), and a 40% reduction in nocturia episodes (p < 0.00). B/H/T patients reported 51% improvement (p < 0.00), increased time between daytime voids by 1.4 h (p < 0.00), and an 8% reduction in nocturia episodes (p = 0.26). When comparing the two treatments, DMSO resulted in a greater percentage of overall improvement (p = 0.02) and a significant decrease in nocturia episodes when compared with B/H/T (p = 0.02). There was no significant difference between treatments for daytime voiding frequency (p = 0.50).


CONCLUSIONS
Bladder instillations with DMSO or B/H/T provide overall symptomatic improvement and improved frequency and nocturia. DMSO appears to provide greater improvement in nocturia and overall.
Department of Obstetrics and Gynecology, Division of Urogynecology, North Shore University Health System, 9650 Gross Point Road., Suite 3900, Skokie, IL, 60076, USA. Siyer@northshore.org.
Shilpa
http://orcid.org/0000-0001-9133-6594
S
Iyer
Department of Obstetrics and Gynecology, Division of Urogynecology, North Shore University Health System, 9650 Gross Point Road., Suite 3900, Skokie, IL, 60076, USA.
Elizabeth
E
Lotsof
Department of Obstetrics and Gynecology, Division of Urogynecology, North Shore University Health System, 9650 Gross Point Road., Suite 3900, Skokie, IL, 60076, USA.
Ying
Y
Zhou
Department of Obstetrics and Gynecology, Division of Urogynecology, North Shore University Health System, 9650 Gross Point Road., Suite 3900, Skokie, IL, 60076, USA.
Alexis
A
Tran
Department of Obstetrics and Gynecology, Division of Urogynecology, North Shore University Health System, 9650 Gross Point Road., Suite 3900, Skokie, IL, 60076, USA.
Carolyn
C
Botros
Department of Obstetrics and Gynecology, Division of Urogynecology, North Shore University Health System, 9650 Gross Point Road., Suite 3900, Skokie, IL, 60076, USA.
Peter
P
Sand
Department of Obstetrics and Gynecology, Division of Urogynecology, North Shore University Health System, 9650 Gross Point Road., Suite 3900, Skokie, IL, 60076, USA.
Roger
R
Goldberg
Department of Obstetrics and Gynecology, Division of Urogynecology, North Shore University Health System, 9650 Gross Point Road., Suite 3900, Skokie, IL, 60076, USA.
Janet
J
Tomezsko
Department of Obstetrics and Gynecology, Division of Urogynecology, North Shore University Health System, 9650 Gross Point Road., Suite 3900, Skokie, IL, 60076, USA.
Adam
A
Gafni-Kane
Department of Obstetrics and Gynecology, Division of Urogynecology, North Shore University Health System, 9650 Gross Point Road., Suite 3900, Skokie, IL, 60076, USA.
Sylvia
S
Botros
D000283:Administration, Intravesical; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D018856:Cystitis, Interstitial / Q000150:complications / Q000188:drug therapy*; D004121:Dimethyl Sulfoxide / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D008875:Middle Aged; D053158:Nocturia / Q000188:drug therapy / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014221:Triamcinolone / Q000008:administration & dosage*
D000893:Anti-Inflammatory Agents; D014221:Triamcinolone; D006493:Heparin; D002045:Bupivacaine; D004121:Dimethyl Sulfoxide
Bladder instillations; Interstitial cystitis; Treatment