多模組治療對於膀胱單一療法無效之間質性膀胱炎/膀胱疼痛症候群患者的臨床療效分析

李雨霜¹、張嘉峰¹、游婉茹²、劉民慶¹、張天霖¹、江元宏¹、郭漢崇¹

¹佛教慈濟醫療財團法人花蓮慈濟醫院泌尿科; ²佛教慈濟醫療財團法人花蓮慈濟醫院護理部

Nomogram of Clinical Interview-Based Assessment Parameters and Urinary Biomarkers in the Diagnosis of IC/BPS

Yu-Shuang Lee¹, Jia-Fong Jhang¹, Wan-Ru Yu², Min-Ching Liu¹, Tien-Lin Chang¹, Yuan-Hong Jiang¹, Hann-Chorng Kuo¹

Department of Urology¹ and Nursing², Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan

Purpose: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic, debilitating condition of unknown etiology, characterized by urinary urgency, frequency, and suprapubic pain associated with bladder filling. This study aimed to evaluate the efficacy of intensive multimodal therapy (MMT), tailored to individual clinical phenotypes and cystoscopic findings, in patients with IC/BPS who had failed prior bladder monotherapies.

Materials and Methods: Thirty-one patients (28 women, 3 men) with refractory IC/BPS were enrolled. Following a comprehensive evaluation, patients received personalized MMT for 3 months. Interventions included anti-inflammatory medications, intravesical hyaluronic acid instillation, intravesical or urethral botulinum toxin A (BoNT-A) injection, pelvic floor BoNT-A injection, platelet-rich plasma (PRP) injection, low-energy shockwave therapy (LESW), pelvic floor massage for pelvic floor muscle pain (PFMP), and/or medications for anxiety, depression, voiding dysfunction, or bladder hypersensitivity. The primary endpoint was the change in O'Leary-Sant Symptom Score (OSS) at 3 months. Secondary endpoints included bladder pain VAS, daytime frequency, nocturia episodes, functional bladder capacity (FBC) from the 3-day voiding diary, Qmax, voided volume, PVR volume, and global response assessment (GRA). Patients were followed for up to 1 year.

Results: Among the 31 patients who completed MMT, 28 were women and 3 were men (1 HIC, 30 NHIC). All participants had previously received intravesical BoNT-A (n=10), PRP (n=13), and/or LESW (n=8), with or without intravesical HA instillations (n=30), without success. The MMT success rate was 58.1% at 3 months, which gradually improved to 67.7% at 9 months and 73.1% at 12 months. At 3 months, treatment success was achieved in 7/8 patients (87.5%) who received intravesical BoNT-A, 10/14 (71.4%) who underwent PFM BoNT-A injection for PFMP, and 13/20 (65.0%) who received PFM massage. There was no significant difference in the mean number of treatment modalities between the successful and failed groups (5.22 ± 1.31 vs. 5.08 ± 1.19, p=0.754). Notably, five patients who had initially failed treatment at 3 months showed gradual improvement during follow-up. By 12 months, only 8 patients (26.9%) required additional bladder therapy.

Conclusion: A precision-driven diagnostic approach that stratifies patients with IC/BPS into clinical subtypes based on distinct pathophysiological profiles may facilitate more tailored and effective management. MMT should incorporate a combination of bladder-directed and extra-bladder interventions to address the heterogeneous mechanisms underlying the disease. Depending on individual presentation, patients benefit from concurrent treatment combinations to optimize symptom relief and long-term outcomes.