sodium-bicarbonate and Cystitis--Interstitial

Recent years have brought dramatic advances in the clinician's ability to offer effective pharmacotherapy to patients who have interstitial cystitis. Medical treatments have been developed and applied to reduce the interstitial cystitis symptoms of pelvic pain and urinary urgency/frequency, and to address underlying causes of the disorder. In addition, advances in the understanding of the natural history of interstitial cystitis have revealed that it is insidiously progressive and the classical definition--rare, severe and difficult to treat--is in fact the relatively uncommon, advanced stage of a disorder that affects most individuals in a mild-to-moderate and readily treatable form. This recognition has led to the identification of large numbers of previously unsuspected cases of interstitial cystitis, and the successful treatment of many individuals in the early stages of interstitial cystitis when it is far more responsive to therapy. A heparinoid-based multimodal medical regimen can effectively control symptoms and address disease pathophysiology in the majority of cases. Intravesical therapeutic solutions are new and promising adjunctive therapies that can offer immediate symptom relief during symptom flares, and for patients who are just beginning medical therapy.

Topics: Administration, Intravesical; Analgesics, Non-Narcotic; Anesthetics, Local; Anti-Inflammatory Agents; Clinical Trials as Topic; Cystitis, Interstitial; Dimethyl Sulfoxide; Diterpenes; Drug Administration Schedule; Drug Therapy, Combination; Heparinoids; Humans; Lidocaine; Neurotoxins; Pelvic Pain; Pentosan Sulfuric Polyester; Sodium Bicarbonate

To test the efficacy of a new intravesical therapeutic solution in relieving urgency/frequency and pain in interstitial cystitis (IC).. A solution of 40,000 U heparin, 8 mL 1% lidocaine (80 mg; group 1) or 2% lidocaine (160 mg; group 2), and 3 mL 8.4% sodium bicarbonate was administered intravesically in patients with newly diagnosed IC with significant frequency, urgency, and pain. Using the Patient Overall Rating of Improvement of Symptoms, the response to treatment was evaluated within 20 minutes of instillation in all patients, after 24 to 48 hours in group 2, and after three treatments per week for 2 weeks in group 2 patients who elected to receive additional instillations. Significant symptom relief was defined as 50% or greater symptom improvement.. After one instillation, 35 (75%) of 47 patients in group 1 (1% lidocaine) and 33 (94%) of 35 in group 2 (2% lidocaine) reported significant immediate symptom relief. The difference in the response rates was statistically significant (P <0.01). In group 2, 50% of the subjects experienced at least 4 hours of symptom relief from the single instillation, and 16 (80%) of 20 reported significant sustained symptom relief after 2 weeks of treatment.. Intravesical treatment with combined heparin and alkalinized lidocaine immediately reduced the pain and urgency of IC in most patients treated for newly diagnosed IC. Symptom relief lasted beyond the duration of the local anesthetic activity of lidocaine, suggesting the solution suppresses neurologic upregulation. In IC treatment, this new intravesical solution may be helpful in the interval before heparinoid therapy reaches its full effect.

Topics: Administration, Intravesical; Adult; Aged; Anesthetics, Local; Cystitis, Interstitial; Drug Therapy, Combination; Female; Heparin; Humans; Hydrogen-Ion Concentration; Instillation, Drug; Lidocaine; Male; Middle Aged; Neurons, Afferent; Pain; Sodium Bicarbonate; Synaptic Transmission; Treatment Outcome

To test the dyspareunia response of patients with interstitial cystitis/painful bladder syndrome treated with an intravesical therapeutic solution of lidocaine, heparin, and sodium bicarbonate.. We studied consecutive patients with interstitial cystitis/painful bladder syndrome who were sexually active and were treated with an intravesical therapeutic solution. All patients provided their medical history, underwent a physical examination, and completed the Pelvic Pain Urgency Frequency symptom scale, voiding diary, and the pain domain (questions 17 to 19) of the Female Sexual Function Index before and after therapy. The patients were treated with intravesical instillations three times weekly for 3 weeks. The patients returned for follow-up 3 weeks later. The patients rated their response using a Patient Objective Rating of Improvement of Symptom scale.. A total of 23 patients (mean age 38 years) were included in this study. Of the 23 patients, 15 (65%) reported improvements of greater than 50% on the Patient Objective Rating of Improvement of Symptom scale. Before and after instillation, nocturia was 4 +/- 2 versus 2 +/- 1 (P <0.001), the voided volume was 98 +/- 59 mL versus 169 +/- 80 mL (P <0.001), the Pelvic Pain Urgency Frequency score was 21 +/- 6 versus 15 +/- 6 (P <0.001), and the Female Sexual Function Index pain domain score was 1.9 +/- 0.9 versus 3.7 +/- 1.6 (P <0.001), respectively. Of the 23 patients, 13 (57%) reported resolution of dyspareunia. Of the 13 patients with bladder tenderness only versus the 7 with multiple tender locations on the vaginal examination, 11 (85%) versus 2 (29%) had resolution of dyspareunia (P <0.01) and 12 (92%) versus 2 (29%) had successful overall outcomes (P <0.01).. The results of this study have demonstrated that an intravesical therapeutic solution provides relief of voiding symptoms, pain, and dyspareunia in patients with interstitial cystitis/painful bladder syndrome. A randomized, prospective trial is warranted.

Topics: Administration, Intravesical; Adult; Comorbidity; Cystitis, Interstitial; Drug Therapy, Combination; Dyspareunia; Female; Heparin; Humans; Lidocaine; Middle Aged; Sodium Bicarbonate

Topics: Administration, Intravesical; Anesthetics, Local; Buffers; Cystitis, Interstitial; Humans; Lidocaine; Pain; Pain Measurement; Sodium Bicarbonate; Urinary Bladder