Bladder-Directed Versus Pelvic Floor Therapy in Women With Interstitial Cystitis / Bladder Pain Syndrome: Preliminary Results
Document Type
Conference Proceeding
Publication Date
4-2023
Publication Title
Journal of Urology
Abstract
INTRODUCTION AND OBJECTIVE: Interstitial cystitis/bladder pain syndrome (IC/BPS) symptoms appear bladder related, though little solid evidence exists linking IC/BPS symptoms to dysfunctional bladder epithelium unless ulcers are present. Growing evidence suggests IC/BPS may be a more diffuse syndrome. The study objective is to compare IC/BPS symptom improvement in pelvic floor versus bladder directed therapies. METHODS: Women 18 to 85 years with history of IC/BPS were randomized to one of two treatment arms: 1. Pelvic Floor Physical Therapy (PFPT), 2. Bladder directed instillation of lidocaine, heparin sulphate, sodium bicarbonate, and Kenalog. All participants received twice weekly treatments for 8 consecutive weeks. Symptom improvement was assessed using 3-day voiding diary, pain assessment, and validated questionnaires: global response assessment (GRA),Interstitial cystitis symptom index (ICSI) and Interstitial cystitis problem index (ICPI), at baseline, treatment mid- and end-points (V8and V17), and 6 months follow-up (V18). Statistical analysis was performed using ANOVA followed by Dunnett's multiple comparison. RESULTS: 31 women were enrolled and randomized to PFPT(n[15) or Instillation (n[16) arm with average age of 46.8 and 48.7respectively. By end of treatment 67% in PFPT versus 54% in instillation group reported significant improvement of symptoms (GRA). Uri-nary frequency was significantly reduced in PFPT group at all timepoints (Figure 1) and was resolved or improved in 75% of patients in PFPT compared to 33% in instillation group. Both treatments significantly improved Maximum pelvic pain, but reduction in pain was no longer significant in PFPT group by V18 (Figure 1). Pain Catastrophizing Scale scores followed the same trend. Urgency did not improve with either treatment. ICSI and ICPI scores were significantly reduced by V8 and remained constant up to V18. No severe adverse events were reported. Four patients developed urinary tract infections during treatment, 1 in PFPT and 3 in instillation group. CONCLUSIONS: Both treatments significantly improved IC/BPS symptoms, with patients in PFPT reporting higher GRA scores and frequency improvement. In contrast, instillation appeared superior in reducing maximum pelvic pain long-term
Volume
209
Issue
4S
First Page
e149
Recommended Citation
Zwaans B, Kosovich L, Sirls L, Gilleran J, Smith C, Padmanabhan P, et al. [Chancellor M, Peters K]. Bladder-directed versus pelvic floor therapy in women with interstitial cystitis / bladder pain syndrome: preliminary results. J Urol. 2023 Apr;209(4S):e149. doi:10.1097/JU.0000000000003229.03. and Continence. 2023 Sep;7(Suppl 1):100814. doi:10.1016/j.cont.2023.100814.
DOI
10.1097/JU.0000000000003229.03
Comments
American Urological Association Annual Meeting, April 28 - May 1, 2023, Chicago, IL
International Continence Society Annual Meeting, September 27-29, 2023, Toronto, Canada