Study Supports Treating the Bladder Component of Pelvic Pain


SAN DIEGO — Using intravesical anesthetic treatment and pentosan polysulfate to treat chronic pelvic pain was linked to a significant improvement in symptoms 9 weeks after bladder rescue therapy, a study of 47 women has shown.

The finding “clearly demonstrates that treating the bladder component of pelvic pain can result in significant improvement of symptoms,” Jackie Shriver, a certified registered nurse practitioner with the Lima, Ohio-based Midwest Center for Chronic Pelvic Pain and Bladder Control reported at an international congress of the Society of Laparoendoscopic Surgeons.

In a study led by the center's director, Maurice K. Chung, M.D., investigators conducted a prospective analysis of 47 women aged 21–74 who had a diagnosis of chronic pelvic pain and gynecologic-related symptoms for 6 months. At the initial visit, the women filled out questionnaires that included the Pelvic Pain and Urgency/Frequency (PUF) scale, the American Urological Association (AUA) score, and the Interstitial Cystitis Symptomatology Index (ICSI) score.

Six weeks later, all women underwent potassium sensitivity testing (PST) in the office and filled out the same questionnaires. Of the 47 women, 41 (87%) tested positive on the PST.

The women then underwent intravesical anesthetic treatment and pentosan polysulfate therapy for 9 weeks and filled out the same three questionnaires at the end of treatment.

Intravesical therapy was a solution of 10-cc lidocaine 1%, 10-cc bupivacaine 0.5%, 5-cc sodium bicarbonate, and 40,000-U/4-cc heparin, given biweekly for 3 weeks and then weekly for 6 weeks.

The dosage of pentosan polysulfate therapy was 200 mg b.i.d.

The average baseline scores were 14.8 for the PUF, 13.1 for the AUA, and 8.4 for the ICSI. The 6-week rescreening scores were similar: 15.2 for the PUF, 13 for the AUA, and 8.5 for the ICSI.

However, 9 weeks after bladder rescue therapy, the average scores were 11.1 for the PUF, 9.4 for the AUA, and 5.8 for the ICSI. This demonstrated “significant improvement in symptoms,” Ms. Shriver said.

In an interview, Dr. Chung said wide adoption of this approach could reduce the number of hysterectomies performed in the United States each year. He estimated that 10%–20% of hysterectomies result from a diagnosis of chronic pelvic pain.

The study received an honorable mention by the meeting organizers.

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