What’s new in the diagnosis and management of painful bladder syndrome/interstitial cystitis?

Abstract

Painful bladder syndrome/interstitial cystitis (PBS/IC) is a controversial subject. Despite its many controversies, recent data on diagnostics show that cystoscopy and hydrodistension findings may not be sensitive or specific. Diagnosis is suggested primarily on the basis of history. Antiproliferative factor and Tamm-Horsfall protein are novel tests that may prove to be worthwhile pending future studies. Currently, there is no single diagnostic gold standard. Recent data on therapeutics show that, among oral therapies, amitriptyline and pentosan are efficacious. For best response, pentosan should be initiated early and used for a minimum of 6 months. Immune-modulating agents show promise but are limited by side effects. Intravesical alkalinized lidocaine with heparin may be effective for rapid symptom relief, pending results of prospective randomized trials. Intravesical botulinum toxin A, bacille Calmette-Guérin, and sacral neuromodulation may have a role in select patients.

Combined Use of Duloxetine and Olanzapine in the Treatment of Urologic Chronic Pelvic Pain Syndromes Refractory to Conventional Treatment: A Case Report

“… 13) The most frequent therapies for UCPPS include single or sequential treatments or multimodal approaches with antibacterial, analgesics, and anti-inflammatory drugs, a-blockers, and pelvic floor rehabilitation to treat dysfunctional voiding, but the treatment is not always effective. 14) …”

The Value of Botox-A in Acute Radiation Proctitis: Results From a Phase I/II Study Using a Three-Dimensional Scoring System

“…Traditional treatment options are oral and intravesical agents, neurostimulation, vaginal massage, and surgery; but none of these regimens is very effective (44)(45)(46). Neurogenic inflammation has been identified as an important component of this medical condition (47).…”

Dispareunia masculina

“…En la dispareunia post-herniorrafía inguinal se indican los bloqueadores alfa-adrenérgicos o fármacos usados en el dolor neuropático para inhibir la contractilidad y mejorando el movimiento de los conductos deferentes. A los pacientes que padecen cistitis intersticial se les han prescrito varias terapias que incluyen pentosan polisulfato de sodio, amitriptilina, lidocaína alcalinizada intravesical con heparina, toxina botulínica intravesical y neuromodulación sacra 52 . No hay un tratamiento simple ni único por lo que la terapia de combinación con dos o más agentes se ha recomendado en hombres como terapia óptima 53,54 .…”