Prospective study of intravesical dimethyl sulfoxide in treatment of suspected early interstitial cystitis

The efficacy of intravesical instillations of dimethyl sulfoxide (DMSO) in the treatment of suspected early interstitial cystitis was investigated in a prospective study. Among 20 patients treated, complete symptomatic remissions were achieved in 3, partial symptomatic remissions were achieved in 16, and 1 had no symptomatic improvement. However, functional bladder capacities following treatment were increased by more than 25 per cent in only 4 cases. Among 16 patients who experienced symptomatic remissions and who have been followed for > four months, 14 had sustained remissions (mean follow-up eleven months) and 2 had unsustained remissions. Clinically apparent toxicity was minimal but transient elevation of the serum lactic acid dehydrogenase was occasionally observed during treatment. DMSO appears to be useful in the management of carefully selected patients with suspected early interstitial cystitis.     

Eosinophilic cystitis after bladder instillation with dimethyl sulfoxide

Eosinophilic cystitis is a rare and poorly understood disorder. We report the first case of an acute flare of eosinophilic cystitis in a 51-year-old woman after bladder instillation with dimethyl sulfoxide (DMSO) for presumed interstitial cystitis. The patient presented with severe bladder pain, fever, and eosinophilia several hours after instillation. These symptoms were unresponsive to conventional analgesic and antibiotic treatments. Cystoscopy revealed erythema and exudate at the bladder walls, along with edema of both ureteral orifices. Bladder biopsies demonstrated massive eosinophilic infiltration of the bladder, confirming the diagnosis of eosinophilic cystitis. Urologists should bear in mind this clinical entity, particularly when DMSO is administered to patients with multiple drug allergies.     

The use of dimethyl-sulfoxide (DMSO) in the treatment of interstitial cystitis.

Dimethyl-sulfoxide (DMSO) was used in 17 patients with interstitial cystitis. The diagnosis was made on the basis of clinical and laboratory findings and the characteristic picture with Hunner ulcera. The majority of the patients had responded poorly to other forms of conservative treatment. Subjective symptoms were controlled in 2/3 of the cases but repeated treatment was needed and 5 patients did not respond to the therapy. The DMSO treatment is an alternative worth to try and has in some cases a dramatic and lasting effect.     

Long-term outcomes of intravesical dimethyl sulfoxide/heparin/hydrocortisone therapy for interstitial cystitis/bladder pain syndrome

Introduction and hypothesis

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.

     

Measuring the success of combined intravesical dimethyl sulfoxide and triamcinolone for treatment of bladder pain syndrome/interstitial cystitis

Introduction and hypothesis

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.     

Risk factors that affect the treatment of interstitial cystitis using intravesical therapy with a dimethyl sulfoxide cocktail

Introduction and hypothesis

Dimethyl sulfoxide (DMSO) bladder instillation is a standard therapy for interstitial cystitis (IC); however, there are varying degrees of success. We hypothesize that first-line intravesical therapy with a DMSO cocktail will optimize treatment outcome.

Methods

Ninety women with newly diagnosed IC were enrolled consecutively for the treatment. The IC symptom and problem index was used as an outcome measure.

Results

Six (6.7%) patients dropped out of the treatment due to intolerable bladder irritation. Fifty-five (65.5%) of the remaining 84 patients, who completed the treatment, experienced ≧50% symptomatic improvement. After a regression analysis, three clinical variables were found to affect treatment adversely, i.e., the presence of advanced cystoscopic glomerulations, microscopic hematuria, and urodynamic detrusor underactivity, respectively.

Conclusions

Our results suggest bladder instillation with a DMSO cocktail may well be considered as first-line therapy for IC patients. However, there exists a subgroup of nonresponders who may have severe disease.     

Epithelial dysfunction in nonbacterial cystitis (interstitial cystitis)

Traditional concepts of impermeability of the bladder have centered around unique cellular tight junctions and ion pumps. However, recent data from our laboratory have shown that the bladder epithelium in animals and humans relies primarily on its surface glycosaminoglycans to maintain its impermeability. This study demonstrates the first disease associated with an epithelial dysfunction of the bladder, that is a leaky epithelium. The study consisted of 31 normal subjects and 56 individuals with interstitial cystitis. Interstitial cystitis patients were shown to have a leaky epithelium by placing a solution of concentrated urea into the bladder and measuring the absorption. The normal subjects absorbed 4.3% in 45 minutes, while the interstitial cystitis patients absorbed 25% (difference is highly significant, p less than 0.005). Interstitial cystitis patients with Hunner's ulcers (10) had a 34.5% absorption rate, while those without ulcers absorbed 22.8% (46). This difference also was highly significant (p = 0.002) and supports the concept that patients with ulcers have clinically worse disease.     

Intravesical bacillus Calmette-Guerin and dimethyl sulfoxide for treatment of classic and nonulcer interstitial cystitis: a prospective, randomized double-blind study

PURPOSE: We conducted a prospective, double-blind study with a crossover design of intravesical bacillus Calmette-Guerin (BCG) and dimethyl sulfoxide to determine whether patients with classic and nonulcer interstitial cystitis, respectively, might benefit from either regimen. MATERIALS AND METHODS: A total of 21 patients, including 11 with classic and 10 with nonulcer interstitial cystitis, randomly underwent treatments with intravesical BCG or dimethyl sulfoxide and, if not improved, were treated with the other substance after a washout period. All 21 patients were evaluated with symptom questionnaires, including a visual analog pain scale and voiding diaries. RESULTS: Regardless of regimen, there was no improvement in maximal functional capacity. There was a reduction in urinary frequency following dimethyl sulfoxide treatment but only in the classic subtype (p <0.05), whereas no reduction was seen following BCG in either subtype. A substantial pain decrease was noted in classic (p <0.05) as well as nonulcer (p <0.05) interstitial cystitis following dimethyl sulfoxide. CONCLUSIONS: Intravesical BCG has been presented as a promising new option for treatment of interstitial cystitis. We failed to demonstrate benefit from this treatment. Dimethyl sulfoxide had no positive effect on maximal functional capacity but resulted in a significant reduction in pain and urinary frequency, although only in patients with classic interstitial cystitis.     

阿米替林与二甲基亚砜治疗间质性膀胱炎的临床研究

目的探讨口服阿米替林及膀胱灌注二甲基亚砜（DMSO）治疗间质性膀胱炎的临床有效性及安全性。方法2004年7月~2008年5月,采用美国国立肾病、消化病和糖尿病研究所（NIDDK）制定的标准诊断间质性膀胱炎19例,口服阿米替林25mg／d。治疗1周效果不佳的患者加服阿米替林至50mg／d,最大不超过75mg／d。对无效或不能耐受阿米替林副作用的患者加用50％DMSO50mL膀胱灌注连续10次（其中2例用50％DMSO50mL＋1万单位低分子肝素钠灌注）,总疗程3个月。观察指标：O’Leary间质性膀胱炎症状指数、间质性膀胱炎问题指数、视觉疼痛模拟量表及排尿日记。结果19例患者均完成治疗,17例患者取得良好的效果,2例患者效果较差。结论口服阿米替林及膀胱灌注DMSO是治疗间质性膀胱炎简单有效的方法,可以缓解患者的临床症状,提高生活质量,其副作用可以被大多数患者耐受。     

Pentosanpolysulphate for interstitial cystitis

Interstitial Cystitis (IC) is a chronic disease of unknown etiology which primarily affects women aged 40–60 years. Many plausible theories for the development of IC have been postulated, and one current theory is that these patients have a quantitative and qualitative defect in the glycosaminoglycan (GAG) layer of the urothelium. Such a defect may allow toxic substances in the urine to gain access to the lamina propria and initiate a chronic inflammatory process. Pentosanpolysulphate (PPS) is a sulphated proteoglycan similar in structure to heparin sulphate, which is quantitatively the major GAG on cell surfaces. Exogenously administered PPS has been shown in several studies to decrease bladder pain and urinary frequency and to increase the voided volume. Further studies are required to evaluate the role of PPS in the management of IC patients, with particular emphasis on dosage, route of administration and combination with other compounds.     

Global concepts of bladder pain syndrome (interstitial cystitis)

Background

Bladder pain syndrome (BPS), commonly referred to as “interstitial cystitis”, is no longer considered a rare disorder. It may affect up to 2.7% of the adult female population (Ueda et al. in Int J Urol 10:1–70, 2003) with up to 20% of cases occurring in men.

Methods

The last two decades have seen a worldwide effort to try to standardize its nomenclature, definition, diagnosis, and treatment algorithm. The literature has been reviewed.

Results

In this article, we will detail current terminology, diagnostic approaches and treatment. Standard therapies will be discussed, and a section that concentrates on the management of the subset of patients with a Hunner’s lesion will be highlighted.

Conclusions

BPS is today viewed through a new paradigm. It is no longer considered primarily a bladder disease, but rather one of a number of chronic pain syndromes that is distinguished by being manifest through bladder-related symptoms. A distinct subgroup of patients with Hunner’s lesion has specific characteristics, and successful treatment of this subgroup is available.