密集多模式療法對間質性膀胱炎/膀胱疼痛綜合症患者的治療效果

黃子修、郭漢崇

花蓮慈濟醫院 泌尿部

Therapeutic efficacy of intensive multimodal therapy for patients with interstitial cystitis/bladder pain syndrome

Tsu-Hsiu Huang, Hann-Chorng Kuo

Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien, Taiwan

Introduction and Purpose: Interstitial cystitis/ bladder pain syndrome (IC/BPS) is a debilitating chronic disease of unknown etiology. Current medical treatments are usually unsuccessful in completely eradicating bladder pain and increasing bladder capacity. Intravesical hyaluronic acid (HA) instillation, botulinum toxin A (BoNT-A) intravesical injection, autologous platelet-rich plasma (PRP), low energy shock wave (LESW) have been used for IC/BPS, however, none of these treatments can provide durable treatment outcome for IC/BPS. Anxiety and depression are also commonly noted in patients with IC/BPS. Moreover, pelvic floor muscle pain (PFMP) and voiding dysfunction due to urethral sphincter dysfunction or poor relaxation of pelvic floor muscle are frequently encountered in these patients. Monotherapy cannot effectively improve IC symptoms, but multimodal therapy (MMT) might provide a durable effective treatment outcome. This clinical study attempts to treat IC/BPS patients with intensive MMT within 3-month treatment period, and expect MMT might provide a durable effective treatment outcome.

Methods: Eligible patients were investigated thoroughly for anxiety and depression severity, IC symptoms, bladder pain score, bladder condition after cystoscopic hydrodistention, voiding condition by videourodynamic study, and pelvic floor examination to disclose the tender point. Then the patients were treated with appropriate therapies based on their clinical findings, including intravesical HA, BoNT-A, PRP therapy, urethral BoNT-A injection, pelvic floor BoNT-A injection, LESW and pelvic floor massage for pelvic floor muscle pain, and medication for voiding dysfunction or bladder hypersensitivity (Table 1). Urine samples (30 ml) were collected at baseline and primary end-point. Primary end-point is the change of the O’Leary-Sant symptom score (OSS, including ICSI and ICPI) from baseline to 6 months after the first injection day.

Results:  A total of 27 patients received MMT therapy based on patients’ clinical characteristics and cystoscopic findings. The preliminary results showed that 11 (55%) of 20 patients who completed the treatment had a GRA ≥2. We can also compare the treatment results among IC patients with different clinical demographics at baseline such as bladder pain severity, bladder capacity, glomerulation grade, and pelvic floor pain. The results of this study could provide evidence for clinicians to choose appropriate patients for appropriate multimodal therapy. A diagnostic and treatment strategy algorithm was constructed for the intensive MMT therapy for IC/BPS.

Conclusion: MMT for patients with IC/BPS is mandatory to simultaneously correct the underlying pathophysiology and enable patients to achieve a favorable treatment outcome in a short period.

Table 1. The multiple and concomitant treatment modalities chosen based on the clinical assessment results