Advances in intravesical therapy for urinary tract disorders

Abstract

Introduction Intravesical therapy is a valuable option in the clinical management of urinary tract disorders such as interstitial cystitis/ painful bladder syndrome (IC/PBS) and refractory overactive bladder. This review will cover the latest advances in this field using polymer and liposomes as delivery platform for drugs, protein and nucleic acids. Areas covered This review summarizes the significance of intravesical therapy for lower urinary tract disorders. The recent advancement of liposomes as a drug delivery platform for botulinum toxin, tacrolimus and small interfering RNA is discussed. The importance of polymers forming indwelling devices and hydrogels are also discussed, where all preparations improved efficacy parameters in rodent models. Clinical experience of treating IC/PBS with indwelling devices and liposomes are summarized and preclinical evidence about the downregulation of target gene expression in rodent bladder with liposomes complexed with siRNA is also reviewed. Expert opinion There have been several advances in the field of intravesical therapy for improving clinical outcomes. One of the most promising research avenues is the repurposing of drugs, given previously by other routes of administration, such as tacrolimus. Intravesical therapy also opens up novel therapeutic targets with improved efficacy and safety for underactive bladder.

Intravesical liposome therapy for interstitial cystitis

“…Animals were pretreated with ODN and siRNA before the exposure to insults (acetic acid and lipopolysaccharide), and the treatment efficacy was confirmed by functional and molecular end‐points. Liposomes can improve the bladder uptake of nucleic acids …”

“…The change of T1 relaxation time of bladder wall tissue after instillation can be a measure of drug delivery . Another option is near‐infrared fluorescence imaging for low absorption and scattering of photons within the near‐infrared region in animals . The deeper penetration of near‐infrared light compared with visible wavelengths allows for the possibility of deeper‐tissue imaging, as well as the possibility of long‐term imaging without off‐target effects of excitation.…”

Intravesical dexmedetomidine instillation reduces postoperative catheter-related bladder discomfort in male patients under general anesthesia: a randomized controlled study

“…These studies were based on the intravenous administration of dexmedetomidine, which increases the risk of arrhythmia. [22] A large number of studies [23][24][25] showed that intravesical instillation is an effective way of drug administration, which exerts an obvious effect on the treatment of bladder-related diseases. Concurrently, the intravesical instillation of drugs can reduce the systemic response.…”

Minimally invasive device for intravesical instillation by urological syringe adapter (MID‐ii U.S.A.) for catheter‐free instillation therapy of the bladder in interstitial cystitis/bladder pain syndrome

“…Local instillation therapy of the bladder is a generally accepted and widely used treatment modality of the bladder in different pathological conditions. Its advantages are the locally high concentration of the active drug and the reduced level of systemic side effects …”

“…Its advantages are the locally high concentration of the active drug and the reduced level of systemic side effects. 1 Intravesical instillation therapy is at present most frequently applied in cases of superficial bladder cancer to reduce the rate of local recurrence, 2 and in the treatment of IC/BPS. 3,4 Intravesical drug delivery has also been reported to be efficacious in chronic bacteriological bladder infections, 5 refractory overactive bladder, 6 and following pelvic radiotherapy.…”