Older drug, versatile clinicians may help IC/PBS patients
lnterstitial cystitis/painful bladder syndrome (IC/PBS), also known as painful bladder syndrome, chronic pelvic pain, and bladder pain syndrome, affects over 12 million people in the United States, according to the Interstitial Cystitis Association. Suffering from pelvic pain, pain on bladder holding, frequent urination both day and night, the patient with IC/PBS has difficulty locating providers who understand this syndrome, and many of them see several providers before the condition is diagnosed.
There are two distinct types of IC/PBS: with or without Hunner lesions. These two types differ in both pathophysiology and treatment. The type with Hunner lesions is associated with severe bladder inflammation on biopsy and is the type most likely to respond to anti-inflammatory treatments.
As reported in Urology Times, a recent study from Shoskes et al provides additional evidence regarding IC/PBS treatment. Cyclosporine A was first evaluated and found to be effective as an IC/PBS treatment in Finland. It was also found to be effective in other countries, especially for the type with Hunner lesions.
Unfortunately, it has significant side effects and risks including unusual infections and increased risk of malignancy. Patients require close monitoring and follow-up, including regular office visits for history, exam, blood work, and following for dose adjustments. Some patients with Hunner lesions find the commitment, and even the serious risks, are justified by their significant symptom improvement (in some cases, complete symptom resolution).
The AUA guideline for IC/PBS lists cyclosporine as its fifth-tier option in the treatment of IC/PBS. As described by the AUA on the “Why Urology” page of its website, “Although urology is classified as a surgical specialty, knowledge of internal medicine, pediatrics, gynecology, and other specialties is required by the urologist because of the wide variety of clinical problems encountered.”
It may be that urologists need to rely more on their internal medicine instincts to find new ways to treat conditions such as IC/PBS by examining treatments that may be outside the typical urology armamentarium. Let us not forget sildenafil citrate (Viagra) and onabotulinumtoxinA (Botox), two examples of medications not initially discovered or intended for use in urologic patients yet now utilized to improve symptoms and quality of life—and two examples of thinking outside the routine or obligatory box.
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