Prospective comparative study of the effects of lidocaine on urodynamic and sensory parameters in bladder pain syndrome

Abstract

Introduction and hypothesis Intravesically administered lidocaine is used in patients with bladder pain syndrome (BPS) to test the hypothesis that symptoms have a peripheral versus central mechanism. Methods A cross-sectional study of 24 female patients with BPS was performed. The Central Sensitisation Inventory (CSI) and Kings Health Questionnaire (KHQ) were completed. Urodynamic assessment was undertaken. Women were asked to report their pain using a numeric rating scale at cystometric capacity and post void. Participants then received an intravesical instillation of either 20 ml of 2% alkalinised lidocaine ( n = 16) or 20 ml of normal saline ( n = 8). These solutions were allowed to remain in situ for 20 min and pain score repeated. Urodynamics was repeated. Results There was a statistically significant volume increase following lidocaine treatment: maximal cystometric capacity (MCC) 192–261 ml post lidocaine ( p = 0.005.) In contrast, there was no significant difference in the saline controls: MCC 190–183 ml ( p = 0.879.) Individual analysis revealed five of 16 lidocaine participants did not respond to lidocaine. These five reported a significantly worse quality of life (QoL) than lidocaine responders and had a tendency towards central sensitivity syndromes. Conclusion Lidocaine significantly improved MCC in 11/16 participants in this study. These patients appear to have peripherally mediated disease. However, the failure of response to treatment in five participants, as well as their tendency towards central sensitivity syndromes, implies that in this subgroup, a peripheral drive from the bladder is not critical to their pain, suggesting central nervous system (CNS) pathology. This simple and safe test could be used to stratify patients for research or therapeutic trials. Electronic supplementary material The online version of this article (10.1007/s00192-019-03892-2) contains supplementary material, which is available to authorized users.

Current Status of Intravesical Therapies for Bladder Pain Syndrome (BPS): A Narrative Review of Emerging Evidence

“…Lidocaine, a non-selective sodium channel blocker, is a well-known and powerful local anaesthetic agent owing to its ability to block pain but allow the patient to remain conscious (Table 1) [10]. It has been used as a treatment strategy for BPS since the first description in 1989 [11].…”

Indwelling urinary catheter assembled with lidocaine‐loaded polymeric strand for local sustained alleviation of bladder discomfort

“…To examine the efficacy of sustained‐release lidocaine, we assessed the CMG profile of the animals with a normal or cystitis‐induced bladder implanted with different types of IUCs. Animals with a cystitis‐induced bladder represent a bladder pain syndrome involving an overactive bladder, urinary urgency, and high inflammation in the bladder 41 . CMG analysis is a diagnostic procedure that can assess bladder function, 42 a higher sensitivity of the bladder shows an increase in bladder pressure (i.e., the maximum and minimum pressures and the difference between the two) and a decrease in the interval between consecutive detrusor contractions.…”

Does cystoscopy method affect the investigation of bladder pain syndrome/interstitial cystitis?

“…Low bladder capacity can be associated with more severe symptom severity and Hunner’s lesions [ 11 , 22 , 23 ]. Urodynamic studies have shown that the maximum bladder capacity can be increased in women with bladder pain following administration of 20 ml of 2% alkalinised lidocaine to the bladder for 20 min [ 24 ]. Pain and the use of local anaesthetic gel may therefore have an impact on the accuracy of bladder capacity if determined by FC.…”