UroToday - In a study designed to assess the course of bladder pain syndrome and whether the treatment algorithm can be modified according to baseline data, no dramatic findings were identified to aid the clinician. Dr. Libor Zamecnik and colleagues from Prague characterized and followed 58 patients with interstitial cystitis who had subjective, cystoscopic, and histopathologic findings of the disorder for a mean of 6 years. Out of this well-categorized group, 31 patients were treated with oral pharmacotherapy and 27 patients were treated by intravesical application of heparin.

The authors noted that the higher the patient's age, the longer the time to diagnosis and the more severe the symptomatology based on cystometric bladder capacity, visual analogue pain score, and Interstitial Cystitis Symptom Index (ICSI). The ICSI score correlated positively only with age. The authors assessed whether patients age, total disease duration, and time to diagnosis had an effect on the therapeutic results, and found none. Intravesical therapy was more efficacious than oral therapy for patients with higher mast cell counts in the lamina propria and interstitium.

Overall, the authors report that intravesical heparin instillations outperformed oral therapy. They could not find any relationship between age, disease duration, time to diagnosis and type and effect of treatment in these 58 patients. The exact type of oral therapy used by this Czech group is not made clear in the manuscript. The authors conclude that the criteria of the European Society for the Study of Interstitial Cystitis and the management algorithm cannot be simplified at this time based on the characterization of the patient by standard techniques.

Zámecník L, Hanus T, Pavlík I, Dundr P, Povýsil C

Urol Int. 2009;83(2):193-9.

UroToday Contributing Editor Philip M. Hanno, MD, MPH

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