Intravesical Non-Alkalinized Lidocaine Instillation for Interstitial Cystitis/Bladder Pain Syndrome Patients

Teiichiro Aoyagi, Masaaki Tachibana

Tokyo Medical University, Ibaraki Medical Center, Inashiki, Japan.

DOI: 10.4236/oju.2012.24040                

Abstract

Purpose: The effectiveness of daily or weekly instillation of non-alkalinized lidocaine for patients suffering interstitial cystitis and/or bladder pain syndrome was evaluated retrospectively. Patients and methods: Five female patients (40 - 71 years old) diagnosed as interstitial cystitis by cystoscopic findings and a 68 year-old bladder pain syndrome patient were enrolled. All patients, having interstitial cystitis, had undergone hydrodistention therapy previously and had not improved their symptoms by empirical therapies. Daily or weekly (upon their severity of symptoms) intravesical instillation of 20 ml of 4% non-alkalinized (pH 6.0 - 7.0) lidocaine solution was performed for several times, and patients were asked to keep them in the bladder as long as two hours each time. Previous medications such as anti-cholinergic drugs and analgesics were continued according to patient's requirements and symptoms. The treatment effect was evaluated comparing O'Leary-Sant Symptom Index for interstitial cystitis patients and visual analog pain scale before and after the series of lidocaine therapies. Results: Instillation was made 6 to 16 times. Patients with interstitial cystitis improved their symptoms from O'Leary-Sant Symptom Index 17.5 to 10, Problem Index from 14.8 to 6 in an average. Crouching pain disappeared in all these patients after the instillation therapy. Severe interstitial cystitis findings on cystoscopy disappeared completely in one patient after the therapy. One patient having bladder pain syndrome reduced her analgesics use, and bladder-filling pain decreased from 7 to 3 as a visual analog scale score. One patient complained palpitation at 11th instillation and abandoned treatment thereafter, otherwise, none of these patients showed side effect concerning lidocaine toxicity. Conclusions: Intravesical non-alkalinized lidocaine instillation therapy for interstitial cystitis/bladder pain syndrome patients were an easy, safe and effective treatment.

Keywords

Bladder Pain Syndrome; Interstitial Cystitis; Lidocaine; Instillation Therapy

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	P. M. Hanno, J. R. Landis, Y. Matthews-Cook, J. Kusek, and L. Nyberg Jr., “The Diagnosis of Interstitial Cystitis Revised; Lessons Learned from the National Institute of Health Interstitial Cystitis Database Study,” The Journal of Urology, Vol. 161, No. 2, 1999, pp. 553-557. doi:10.1016/S0022-5347(01)61948-7
[2]	J. P. van de Merwe, J. Nordling, P. Bouchelouche, et al., “Diagnostic Criteria, Classification, and Nomenclature for Painful Bladder Syndrome/Interstitial Cystitis: An ESSIC Proposal,” European Urology, Vol. 53, No. 1, 2008, pp. 60-67. doi:10.1016/j.eururo.2007.09.019
[3]	M. Fall, F. Oberpenning and R. Peeker, “Treatment of Bladder Pain Syndrome/Interstitial Cystitis 2008: Can We Make Evidence-Based Decisions?” European Urology, Vol. 54, No. 1, 2008, pp. 65-78. doi:10.1016/j.eururo.2008.03.086
[4]	T. C. Lau and J. M. Bengtson, “Management Strategies for Painful Bladder Syndrome,” Reviews in Obstetrics & Gynecology, Vol. 3, No. 2, 2010, pp. 42-48.
[5]	R. Taneja, “Intravesical Lignocaine in the Diagnosis of Bladder Pain Syndrome,” International Urogynecology Journal, Vol. 21, No. 3, 2010, pp. 321-324. doi:10.1007/s00192-009-1045-0
[6]	P. M. Hanno, D. A. Burks, J. Q. Clemens, et al., “Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome,” 2011. http://www.auanet.org/content/clinical-practice-guidelines/clinical-guidelines/main-reports/ic-bps/diagnosis_and_treatment_ic-bps.pdf
[7]	M. P. O’Leary, G. R. Sant, F. J. Fowler Jr., K. E. Whitmore and J. Spolarich-Kroll, “The Interstitial Cystitis Symptom Index and Problem Index,” Urology, Vol. 49, No. 5A, 1997, pp. 58-63. doi:10.1016/S0090-4295(99)80333-1
[8]	J. Nordling, M. Fall and P. M. Hanno, “Global Concepts of Bladder Pain Syndrome (Interstitial Cystitis),” World Journal of Urology, Vol. 30, No. 4, 2012, pp. 457-464. doi:10.1007/s00345-011-0785-x
[9]	G. Chiang, P. Patra, R. Letourneau, et al., “Pentosanpolysulfate Inhibits Mast Cell Histamine Secretion and Intracellular Calciumion Levels: An Alternative Explanation of Its Beneficial Effect in Interstitial Cystitis,” The Journal of Urology, Vol. 164, No. 6, 2000, pp. 2119-2125. doi:10.1016/S0022-5347(05)66981-9
[10]	C. L. Parsons, T. Housley, J. D. Schmidt and D. Lebow, “Treatment of Interstitial Cystitis with Intravesical Heparin,” British Journal of Urology, Vol. 73, No. 5, 1994, pp. 504-507. doi:10.1111/j.1464-410X.1994.tb07634.x
[11]	T. Ueda, M. Tamaki, O. Ogawa, T. Yamauchi and N. Yoshimura, “Improvement of Interstitial Cystitis Symptoms and Problems That Developed during Treatment with Oral IPD-1151T,” The Journal of Urology, Vol. 164, No. 6, 2000, pp. 1917-1920. doi:10.1016/S0022-5347(05)66917-0
[12]	M. Lazzeri, M. Spinelli, P. Beneforti, et al., “Intravesical Infusion of Resiniferatoxin by a Temporary in situ Drug Delivery System to Treat Interstitial Cystitis: A Pilot Study,” European Urology, Vol. 45, No. 1, 2004, pp. 98-102. doi.org/10.1016/S0302-2838(03)00418-4
[13]	D. Pode, E. Zylber-Kats and A. Shapiro, “Intravesical Lidocaine: Topical Anesthesia for Bladder Mucosal Biopsies,” The Journal of Urology, Vol. 148, No. 3, 1992, pp. 795-796.
[14]	R. Henry, L. Patterson, N. Avery, et al., “Absorption of Alkalinized Intravesical Lidocaine in Normal and Inflamed Bladders: A Simple Method for Improving Bladder Anesthesia,” The Journal of Urology, Vol. 165, No. 6, 2001, pp. 1900-1903.
[15]	J. C. Nickel, R. Moldwin, S. Lee, E. L. Davis, R. A. Henry and M. G. Wyllie, “Intravesical Alkalinized Lidocaine (PDS597) Offers Sustained Relief from Symptoms of Interstitial Cystitis and Painful Bladder Syndrome,” BJU International, Vol. 103, No. 7, 2009, pp. 910-918. doi:10.1111/j.1464-410X.2008.08162.x
[16]	B. K. Welk and J. M. H. Teichman, “Dyspareunia Response in Patients with Interstitial Cystitis Treated with Intravesical Lidocaine, Bicarbonate, and Heparin,” Urology, Vol. 71, No. 1, 2008, pp. 67-70. doi:10.1016/j.urology.2007.09.067
[17]	T. Gurpinar, H. Y. Wong and D. P. Griffith, “Electromotive Administration of Intravesical Lidocaine in Patients with Interstitial Cystitis,” Journal of Endourology, Vol. 10, No. 5, 1996, pp. 443-447. doi:10.1089/end.1996.10.443
[18]	G. T. Tucker and L. E. Mather, “Properties, Absorption, and Disposition of Local Anesthetic Agents,” In: M. J. Cousins, P. O. Bridenbaugh and E. D. Neural, Eds., Blockage in Clinical Anesthesia and Management of Pain, Lippincott-Raven, Philadelphia, 1998, pp. 55-86.
[19]	H. Lee and M. J. Cima, “An Intravesical Device for the Sustained Delivery of the Bladder,” Journal of Controlled Release, Vol. 149, No. 2, 2011, pp. 133-139. doi:10.1016/j.jconrel.2010.10.016
[20]	J. C. Nickel, P. Jain, N. Shore, et al., “Continuous Intravesical Lidocaine Treatment for Interstitial Cystitis/Bladder Pain Syndrome: Safety and Efficacy of a New Drug Delivery Device,” Science Translational Medicine, Vol. 4, No. 143, 2012, p.143ra100. doi:10.1126/scitranslmed.3003804