Bridging pharmacotherapy and minimally invasive surgery in interstitial cystitis/bladder pain syndrome treatment

ABSTRACT

Introduction: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a painful and debilitating clinical entity which is challenging to diagnose and even more difficult to treat. Unfortunately, none of the existing oral and intravesical medications have been established as effective and therefore relevant research is ongoing.

Areas covered: In this review, the authors present established and emerging treatment options for IC/BPS in terms of medication and minimal invasive procedures. Both American and European Urological Association Guidelines recommend multimodal behavioral techniques alongside oral (e.g. amitriptyline and pentosan polysulfate sodium) or minimally invasive treatments (e.g. dimethyl sulfoxide, botulinum toxin, chondroitin sulfate, triamcinolone, hyaluronic acid, and lidocaine). Novel treatment modalities include immunomodulating drugs, stem cell therapy, nerve growth factor, and ASP6294.

Expert opinion: IC/BPS is still a pathophysiological enigma with multifactorial etiopathogenesis that may be controlled but not completely cured. Patient-tailored phenotype-directed multimodal therapy is the most promising treatment strategy. Combined phenotypic categorization with specific biomarkers could help toward better treatment.

KEYWORDS:

• Interstitial cystitis
• bladder pain syndrome
• stem cell therapy
• botulinum toxin
• pentosan polysulfate sodium
• dimethyl sulfoxide

Article highlights

• Interstitial cystitis/bladder pain syndrome (IC/BPS) is a painful and debilitating condition which is both difficult to diagnose and treat.

• None of the existing oral and intravesical medications for IC/BPS have been established as effective and therefore relevant research is ongoing.

• Approved and commercially available therapies have failed to offer a definite remission of symptoms due to limited usefulness in terms of recurrence.

• Immunomodulating drugs, stem cells, the nerve growth factor, and ASP6294 are promising treatment options.

• Patient-tailored phenotype-directed multimodal treatment plans based on relevant biomarkers bear promising results

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

One referee declares that they are a consultant for Farr Labs, which makes a supplement for Interstitial Cystitis. They are also a consultant for Aquinox which has a drug in clinical development for Interstitial Cystitis.

Additional information

Funding

This manuscript was not funded.