New agents for the medical treatment of interstitial cystitis

Abstract

Interstitial cystitis (IC) is a painful, sterile, disorder of the urinary bladder characterised by urgency, frequency, nocturia and pain. IC occurs primarily in women but also in men with recent findings indicating that chronic, abacterial prostatitis may be a variant of this condition. The prevalence of IC has ranged from about 8 - 60 cases/100,000 female patients depending on the population evaluated. About 10% of patients have severe symptoms that are associated with Hunner's ulcers on bladder biopsy; the rest could be grouped in those with or without bladder inflammation. Symptoms of IC are exacerbated by stress, certain foods and ovulatory hormones. Many patients also experience allergies, irritable bowel syndrome (IBS) and migraines. There have been various reports indicating dysfunction of the bladder glycosaminoglycan (GAG) protective layer and many publications showing a high number of activated bladder mast cells. Increasing evidence suggests that neurogenic inflammation and/or neuropathic pain is a major component of IC pathophysiology. Approved treatments so far include intravesical administration of dimethylsulphoxide (DMSO) or oral pentosanpolysulphate (PPS). New treatments focus on the combined use of drugs that modulate bladder sensory nerve stimulation (neurolytic agents), inhibit neurogenic activation of mast cells, or provide urothelial cytoprotection, together with new drugs with anti-inflammatory activity.

Application of Adult and Pluripotent Stem Cells in Interstitial Cystitis/Bladder Pain Syndrome Therapy: Methods and Perspectives

“…Simultaneously, the side effects of the pain-controlling agents should be meticulously considered. Some reports are showing the therapeutic capacities of the natural compounds, such as curcuminoids, flavonoids, aloe vera extract, herbal medicine, and other natural alternative medicines against the IC-related pathological changes [104][105][106][107][108]. These natural compounds possess minimal side effects compared to the chemical agents and, therefore, their clinical application in IC/BPS therapy should be considered in the future.…”

Long-Term Results of Amitriptyline Treatment for Interstitial Cystitis

“…Regarding the antidepressant activity selective serotonin reuptake inhibitors (SSRIs) have similar efficacy but slightly higher tolerability than tricyclic antidepressants and appear to be a valid alternative for treatment of depression [17]. However, communication regarding the efficacy of SSRIs for chronic pain conditions typically reports not much beneficial effect of this drug group [18]. For IC the systematic use of SSRIs has never been reported and case reports on SSRIs for IC that occasionally appear on the internet or are recollected in personal communication report almost exclusively unsatisfying therapeutic outcome.…”

Interstitial cystitis: bladder pain and beyond

“…Behavioral, physical, dietary, oral and intravesical interventions are used, often together, based on the symptoms [5,116]. The most common interventions for interstitial cystitis compiled by the ICDB were bladder hydrodistention, intravesical heparin and oral amitriptyline [117].…”

“…The leukotriene D4 receptor antagonist montelukast (single dose for 3 months) was used in 10 women with interstitial cystitis and detrusor mastocytosis was documented: there was a statistically significant improvement for urinary frequency, nocturia and pain within 1 month of treatment using a visual analog scale [116]. An open-label study also tested the oral prostaglandin agonist misoprostol (600 mg daily for 3 months) in 25 patients with refractory interstitial cystitis: 14 out of 25 (56%) of patients reported a significant improvement [129].…”