The generalist’s guide to interstitial cystitis
How to diagnose and treat all but refractory cases of this not-so-uncommon disease
Alternative therapies
Electrical nerve stimulation
This transcutaneous modality improves symptoms in 25% to 50% of patients.23 It is thought to stimulate the afferent nerves, thereby activating the inhibitory circuits and decreasing the sensation of pain.
Sacral neuromodulation is another modality being studied for the treatment of interstitial cystitis. So far it has significantly reduced urinary urgency-frequency symptoms as well as pain.24
Other new therapies under investigation include intravesical injection of botulinum toxin, resiniferatoxin, gene therapy, and nerve growth-factor inhibitors.
Surgery: High relapse rates make it a last resort
The treatment of visible ulcers by resection or laser ablation improves symptoms but carries a relapse rate of more than 50%.25 More aggressive surgeries, with cure rates ranging from 50% to 80%, include denervation procedures, augmentation cystoplasty for severely contracted bladders (not necessarily due to interstitial cystitis), cecocystoplasty (where a segment of cecum is excised and reanastomosed with the bladder to increase bladder capacity), and total cystourethrectomy and urinary diversion. However, persistent pain has been reported after these invasive procedures, and permanent intermittent self-catheterization and/or reoperation is often required.26,27
Dr. LaSala is a speaker for Pfizer, Inc.
