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Results of Treatment of Refractory Interstitial Cystitis With Intravesical Hyaluronic Acid
VOIDING FUNCTION AND DYSFUNCTION, AND FEMALE UROLOGY
for urgency (n = 306), two for frequency (n = 160), and one study for nocturia (n = 106). The differences (95% confidence limits) were pain: 16.6% (95%CI 8%,25%), NNT = 7; urgency: 13.0% (1.0%, 25%), "T = 7.5; frequency: 16.7% (2.3%, 31.1%), "T = 6; nocturia: -1% (- 19.8%, 21.8%). P values from homogeneity tests were not significant. Mean quality scores were 63.8%, 48.1%, 50.4%, and 65.6%, respectively, in the four studies; the effective inter-rater reliability was 0.96. Results did not differ when weighted by quality score. Conclusions. Pentosan polysulfate is more efficacious than placebo in the treatment of pain, urgency, and frequency associated with interstitial cystitis. Pentosan polysulfate is not significantly different from placebo in treating nocturia associated with interstitial cystitis.
Editorial Comment:This meta-analysis in actuality considered only 4 studies. The percentages refer to the average differences between drug and placebo groups. The ranges of percent difference were 8.3 to 29.4% for pain, 10.9 to 19.6% urgency and 12.8 to 19.1% frequency. Only 1 group was studied for nocturia and there was no difference in this series for nocturia. Are these results significant? You be the judge. It would be interesting to have some quality of life index that compared patients in the drug and placebo groups. The authors make an excellent point about the possibility of subject selection bias, commenting that 2 studies selected contained subjects with moderate or severe disease,whereas in the other 2 studies disease severity was not specified. They recommend that future studies stratify results according to disease severity, which would seem to be an excellent suggestion. Alan J. Wein, M.D. Results of Treatment of Refractory Interstitial Cystitis With Intravesical Hyaluronic Acid D. PORRU,G. CAMPUS, D. TLTDINo, E. VALDES, A. VESPA,R.M. SCARPAAND E. USAI, Clinica Urologica, Uniuersita di Cagliari and Seruizio di Anatomia Patologica, Ospedale SS Trinita, Cagliari, Ztalia Urol. Int., 59: 26-29, 1997 Permission to Publish Abstract Not Granted
Editorial Comment: The results in this article are approximately what one would expect with placebo. Since they are much different than those published by Morales et all in which a complete plus partial response rate of 71% was reported at week 12, a double-blind placebo study is obviously necessary before this avenue of therapy is further pursued. Alan J. Wein, M.D. 1. Morales, A, Emerson, L., Nickel, J. C. and Lundie, M.: Intravesical hyaluronic acid in the treatment of refractory interstitial cystitis. J. Urol., 1 5 6 45, 1996.
Intravesical Electromotive Drug Administration for the Treatment of Non-Infectious Chronic Cystitis C. R. RIEDL,M. KNOLL,E. PLAS,R. L. STEPHEN AND H. PFLUGER, Department of Urology and LudwigBoltzmann-Institute for Urology and Andrology, Municipal Hospital Lainz, Vienna, Austria, and University of Salt Lake City, Salt Lake City, Utah Int. Urogynec. J., 8: 134-137, 1997 Seventeen patients with non-infectious chronic cystitis (NICC) (9 with interstitial cystitis, 6 patients with radiation cystitis, 1with chemocystitis and 1 with lupoid cystitis) were treated with electromotive administration of intravesical lidocaine and dexamethasone followed by hydrodistension of the bladder. Complete resolution of symptoms for an average of 7.5 months was observed in 11 patients (65%), partial improvement in 4 (23.5%). In this series no complications occurred. Electromotive drug administration (EMDA)and cystodistension were well tolerated by all patients. The treatment was performed on an outpatient basis, thus reducing therapeutic costs. The results presented demonstrate that the combination of EMDA and bladder hydrodistension is an effective first-line treatment for NICC patients.
Electromotive Drug Administration of Lidocaine and Dexamethasone Followed by Cystodistension in Women With Interstitial Cystitis A. ROSAMILA, P. L. DWYER AND J. GIBSON, Royal Women's Hospital, Carlton Victoria and Westmead Hospital, Sydney, Australia Int. Urogynec. J., 8 142-145, 1997 Electromotive drug administration (EMDA) involves the active transport of ionized drugs such as lidocaine by the application of an electric current. Twenty-one female subjects with interstitial cystitis were treated with EMDA of lidocaine and dexamethasone, followed by cystodistension. The procedure was convenient and well tolerated, with hospital attendance for 1 hour. Bladder anesthesia was excellent, with cystodistension from a discomfort level of 200 ml to a mean volume of 600 ml. Eighty-five percent had a good response (reduction in frequency and in pain score by 3 or more) at 2 weeks, with 63% still responding a t 2 months. An excellent response (pain score of 0 ) was present in 25% of patients reviewed a t 6 months. These results are comparable to the response following cystodistension under general anesthesia. There is a need
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for urgency (n = 306), two for frequency (n = 160), and one study for nocturia (n = 106). The differences (95% confidence limits) were pain: 16.6% (95%CI 8%,25%), NNT = 7; urgency: 13.0% (1.0%, 25%), "T = 7.5; frequency: 16.7% (2.3%, 31.1%), "T = 6; nocturia: -1% (- 19.8%, 21.8%). P values from homogeneity tests were not significant. Mean quality scores were 63.8%, 48.1%, 50.4%, and 65.6%, respectively, in the four studies; the effective inter-rater reliability was 0.96. Results did not differ when weighted by quality score. Conclusions. Pentosan polysulfate is more efficacious than placebo in the treatment of pain, urgency, and frequency associated with interstitial cystitis. Pentosan polysulfate is not significantly different from placebo in treating nocturia associated with interstitial cystitis.
Editorial Comment:This meta-analysis in actuality considered only 4 studies. The percentages refer to the average differences between drug and placebo groups. The ranges of percent difference were 8.3 to 29.4% for pain, 10.9 to 19.6% urgency and 12.8 to 19.1% frequency. Only 1 group was studied for nocturia and there was no difference in this series for nocturia. Are these results significant? You be the judge. It would be interesting to have some quality of life index that compared patients in the drug and placebo groups. The authors make an excellent point about the possibility of subject selection bias, commenting that 2 studies selected contained subjects with moderate or severe disease,whereas in the other 2 studies disease severity was not specified. They recommend that future studies stratify results according to disease severity, which would seem to be an excellent suggestion. Alan J. Wein, M.D. Results of Treatment of Refractory Interstitial Cystitis With Intravesical Hyaluronic Acid D. PORRU,G. CAMPUS, D. TLTDINo, E. VALDES, A. VESPA,R.M. SCARPAAND E. USAI, Clinica Urologica, Uniuersita di Cagliari and Seruizio di Anatomia Patologica, Ospedale SS Trinita, Cagliari, Ztalia Urol. Int., 59: 26-29, 1997 Permission to Publish Abstract Not Granted
Editorial Comment: The results in this article are approximately what one would expect with placebo. Since they are much different than those published by Morales et all in which a complete plus partial response rate of 71% was reported at week 12, a double-blind placebo study is obviously necessary before this avenue of therapy is further pursued. Alan J. Wein, M.D. 1. Morales, A, Emerson, L., Nickel, J. C. and Lundie, M.: Intravesical hyaluronic acid in the treatment of refractory interstitial cystitis. J. Urol., 1 5 6 45, 1996.
Intravesical Electromotive Drug Administration for the Treatment of Non-Infectious Chronic Cystitis C. R. RIEDL,M. KNOLL,E. PLAS,R. L. STEPHEN AND H. PFLUGER, Department of Urology and LudwigBoltzmann-Institute for Urology and Andrology, Municipal Hospital Lainz, Vienna, Austria, and University of Salt Lake City, Salt Lake City, Utah Int. Urogynec. J., 8: 134-137, 1997 Seventeen patients with non-infectious chronic cystitis (NICC) (9 with interstitial cystitis, 6 patients with radiation cystitis, 1with chemocystitis and 1 with lupoid cystitis) were treated with electromotive administration of intravesical lidocaine and dexamethasone followed by hydrodistension of the bladder. Complete resolution of symptoms for an average of 7.5 months was observed in 11 patients (65%), partial improvement in 4 (23.5%). In this series no complications occurred. Electromotive drug administration (EMDA)and cystodistension were well tolerated by all patients. The treatment was performed on an outpatient basis, thus reducing therapeutic costs. The results presented demonstrate that the combination of EMDA and bladder hydrodistension is an effective first-line treatment for NICC patients.
Electromotive Drug Administration of Lidocaine and Dexamethasone Followed by Cystodistension in Women With Interstitial Cystitis A. ROSAMILA, P. L. DWYER AND J. GIBSON, Royal Women's Hospital, Carlton Victoria and Westmead Hospital, Sydney, Australia Int. Urogynec. J., 8 142-145, 1997 Electromotive drug administration (EMDA) involves the active transport of ionized drugs such as lidocaine by the application of an electric current. Twenty-one female subjects with interstitial cystitis were treated with EMDA of lidocaine and dexamethasone, followed by cystodistension. The procedure was convenient and well tolerated, with hospital attendance for 1 hour. Bladder anesthesia was excellent, with cystodistension from a discomfort level of 200 ml to a mean volume of 600 ml. Eighty-five percent had a good response (reduction in frequency and in pain score by 3 or more) at 2 weeks, with 63% still responding a t 2 months. An excellent response (pain score of 0 ) was present in 25% of patients reviewed a t 6 months. These results are comparable to the response following cystodistension under general anesthesia. There is a need
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