CUA: Interstitial Cystitis (2016): Difference between revisions
Urology4all (talk | contribs) |
Urology4all (talk | contribs) |
||
| (3 intermediate revisions by the same user not shown) | |||
| Line 147: | Line 147: | ||
# '''<span style="color:#ff0000">Cimetidine</span>''' 400 mg po bid | # '''<span style="color:#ff0000">Cimetidine</span>''' 400 mg po bid | ||
# '''<span style="color:#ff0000">Hydroxyzine</span>''' 10–50 mg po qhs (perhaps in patients with an allergy history) | # '''<span style="color:#ff0000">Hydroxyzine</span>''' 10–50 mg po qhs (perhaps in patients with an allergy history) | ||
# '''Pentosan polysulfate''' 100 mg po tid '''(PPS, Elmiron)''' | # '''<span style="color:#ff0000">Pentosan polysulfate</span>''' 100 mg po tid '''(PPS, Elmiron)''' | ||
#* '''Expected benefits are predicted to be marginal''' | #* '''Expected benefits are predicted to be marginal''' | ||
#* Common side effects included: diarrhea (25%); headache (18.2%); nausea (15%); pelvic pain (13%); abdominal pain (13%); and alopecia (5%). | #* Common side effects included: diarrhea (25%); headache (18.2%); nausea (15%); pelvic pain (13%); abdominal pain (13%); and alopecia (5%). | ||
| Line 157: | Line 157: | ||
==== Intravesical ==== | ==== Intravesical ==== | ||
* '''Recommended (3): DMSO, heparin, lidocaine''' | * '''<span style="color:#ff0000">Recommended (3): DMSO, heparin, lidocaine''' | ||
*# '''Dimethylsulfoxide (DMSO)''' | *# '''<span style="color:#ff0000">Dimethylsulfoxide (DMSO)''' | ||
*#* '''MOA: organic solvent with anti-inflammatory and analgesic properties''' | *#* '''<span style="color:#ff0000">MOA: organic solvent with anti-inflammatory and analgesic properties''' | ||
*#* Administered as a 50 mL solution of 50% DMSO with a dwell time of 30‒60 minutes, once weekly for 6 weeks. Monthly maintenance doses may be considered. | *#* Administered as a 50 mL solution of 50% DMSO with a dwell time of 30‒60 minutes, once weekly for 6 weeks. Monthly maintenance doses may be considered. | ||
*#* Overall, favourable safety profile. Typical side effects include halitosis (garlic-like breath, as it is eliminated through the lungs) and potential flare-up after the first instillation, which usually improves after the second one. | *#* Overall, favourable safety profile. Typical side effects include halitosis (garlic-like breath, as it is eliminated through the lungs) and potential flare-up after the first instillation, which usually improves after the second one. | ||
*#* Theoretically may cause dissolution of collagen that could '''potentially cause bladder fibrosis if used on a long-term basis.''' | *#* Theoretically may cause dissolution of collagen that could '''potentially cause bladder fibrosis if used on a long-term basis.''' | ||
*# '''Heparin (alone or in combination)''' | *# '''<span style="color:#ff0000">Heparin (alone or in combination)''' | ||
*#* '''MOA: GAG analogue''' | *#* '''<span style="color:#ff0000">MOA: GAG analogue''' | ||
*#* May be instilled intravesically with '''virtually no systemic absorption''' | *#* May be instilled intravesically with '''virtually no systemic absorption''' | ||
*#* '''DMSO combined with heparin better than DMSO alone''' (further reduces and defers relapses) | *#* '''DMSO combined with heparin better than DMSO alone''' (further reduces and defers relapses) | ||
*# '''Lidocaine''' | *# '''<span style="color:#ff0000">Lidocaine''' | ||
*#* '''MOA: local anesthetic''' | *#* '''<span style="color:#ff0000">MOA: local anesthetic''' | ||
*#* Instillation on a daily or weekly basis of alkalinized lidocaine | *#* Instillation on a daily or weekly basis of alkalinized lidocaine | ||
*#* '''Option for short-term relief IC/BPS symptoms''', primarily bladder pain | *#* '''Option for short-term relief IC/BPS symptoms''', primarily bladder pain | ||
| Line 191: | Line 191: | ||
=== Third-line: minimally invasive surgical procedures === | === Third-line: minimally invasive surgical procedures === | ||
* '''Treatment is recommended for patients with identified Hunner’s lesions''' | * '''Treatment is recommended for patients with identified Hunner’s lesions''' | ||
** Hunner’s lesions can be treated by: | ** '''Hunner’s lesions can be treated by:''' | ||
**# Transurethral resection | **# '''Transurethral resection''' | ||
**# Fulguration with a Bugbee electrode | **# '''Fulguration with a Bugbee electrode''' | ||
**# Transurethral coagulation using neodymium:yttrium-aluminum-garnet (Nd:YAG) laser | **# '''Transurethral coagulation using neodymium:yttrium-aluminum-garnet (Nd:YAG) laser''' | ||
* '''Options in patients with or without Hunner’s lesions (3):''' | * '''<span style="color:#ff0000">Options in patients with or without Hunner’s lesions (3):''' | ||
*# '''Hydrodistension (HD)''' | *# '''<span style="color:#ff0000">Hydrodistension (HD)''' | ||
*# '''Botulinum toxin A (BTX-A)''' | *# '''<span style="color:#ff0000">Botulinum toxin A (BTX-A)''' | ||
*#* Costly, may not be widely available | *#* Costly, may not be widely available | ||
*#* Repeat injections are safe | *#* Repeat injections are safe | ||
*#* Must describe potential side effects, particularly risk of urinary retention and need to catheterize | *#* Must describe potential side effects, particularly risk of urinary retention and need to catheterize | ||
*# '''Sacral neuromodulation (SNM)''' | *# '''<span style="color:#ff0000">Sacral neuromodulation (SNM)''' | ||
*#* Costly, may not be widely available | *#* Costly, may not be widely available | ||
*#* Must describe potential side effects, particularly the need for future surgical revisions | *#* Must describe potential side effects, particularly the need for future surgical revisions | ||