RSS-Feed abonnieren
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0037-1609049
Systematic Review of Oral Therapy for the Treatment of Symptoms of Bladder Pain Syndrome: The Brazilian Guidelines[*]
Revisão sistemática sobre terapia oral para tratamento dos sintomas da síndrome da bexiga dolorosa: as diretrizes brasileiras*Publikationsverlauf
30. Juli 2017
27. Oktober 2017
Publikationsdatum:
14. Dezember 2017 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00030576/201802/lookinside/thumbnails/10-1055-s-0037-1609049_0108-1.jpg)
Abstract
Interstitial cystitis (IC), including bladder pain syndrome (BPS), is a chronic and debilitating disease that mainly affects women. It is characterized by pelvic pain associated with urinary urgency, frequency, nocturia and negative urine culture, with normal cytology. In 2009, the Society for Urodynamics and Female Urology (SUFU) defined the term IC/BPS as “an unpleasant sensation (pain, pressure, and discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms for more than 6 weeks duration, in the absence of infection or other identifiable causes.” This is the definition used by the American Urological Association (AUA) in the most recent guidelines on IC/BPS. Interstitial cystitis may be sufficiently severe to have a devastating effect on the quality of life, but it may also be associated with moderate symptoms whose effects are less debilitating. Although there are several clinical trials to assess oral and intravesical therapies, the treatment for IC remains far from ideal. This systematic assessment evaluates published randomized clinical trials on oral medications used to treat symptoms of BPS. This study was performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) method. Two independent reviewers screened the studies to determine their inclusion or exclusion and to perform the methodological analysis. The inclusion criteria included randomized studies published between April of 1988 and April of 2016 that used oral medications to treat symptoms of BPS or IC. According to the systematic review performed, we should consider pentosan polysulfate as one of the best options of oral drugs for the treatment of BPS symptoms. However, this drug is not an available option in Brazil. Orally administered amitriptyline is an efficacious medical treatment for BPS, and it should be the first treatment offered.
Resumo
Cistite intersticial (IC), incluindo a síndrome da bexiga dolorosa (SBD), é uma doença crônica e debilitante que afeta principalmente mulheres. É caracterizada por dor pélvica associada à urgência miccional, frequência urinária, noctúria e exame cultural de urina negativo, com citologia normal. A cistite intersticial pode ser suficientemente severa para ter um efeito devastador na qualidade de vida, mas também pode estar associada a sintomas moderados e menos debilitantes. Embora existam vários ensaios clínicos para avaliar terapias orais e intravesicais, o tratamento para IC permanece longe do ideal. Esta revisão sistemática avaliou ensaios clínicos randomizados publicados sobre medicamentos orais usados para tratar sintomas de SBD. Este estudo foi realizado de acordo com o método preferred reporting items for systematic reviews and meta-analyses (PRISMA). Dois revisores independentes examinaram os estudos para determinar sua inclusão ou exclusão e para realizar a análise metodológica. Os critérios de inclusão foram: ensaios clínicos randomizados publicados entre abril de 1988 e abril de 2016 que usaram medicações orais no tratamento dos sintomas da SBD ou CI. De acordo com a revisão sistemática realizada, a melhor opção de medicação oral para o tratamento dos SBD é o pentosano polissulfato sódico. No entanto, esta droga não está disponível no Brasil. A amitriptilina administrada por via oral é um tratamento eficaz para SBD e deve ser oferecida como primeira escolha.
* This study has the approval of the Febrasgo Specialized National Commission of Urogynelogy.
-
References
- 1 van Ophoven A, Pokupic S, Heinecke A, Hertle L. A prospective, randomized, placebo controlled, double-blind study of amitriptyline for the treatment of interstitial cystitis. J Urol 2004; 172 (02) 533-536 . Doi: 10.1097/01.ju.0000132388.54703.4d
- 2 Korting GE, Smith SD, Wheeler MA, Weiss RM, Foster Jr HE. A randomized double-blind trial of oral L-arginine for treatment of interstitial cystitis. J Urol 1999; 161 (02) 558-565 . Doi: 10.1016/S0022-5347(01)61950-5
- 3 Nickel JC, Crossland A, Davis E. , et al. Investigation of a Ca2+ channel α2δ ligand for the treatment of interstitial cystitis: results of a randomized, double-blind, placebo controlled phase II trial. J Urol 2012; 188 (03) 817-823 . Doi: 10.1016/j.juro.2012.05.010
- 4 Nickel JC, Barkin J, Forrest J. , et al; Elmiron Study Group. Randomized, double-blind, dose-ranging study of pentosan polysulfate sodium for interstitial cystitis. Urology 2005; 65 (04) 654-658 . Doi: 10.1016/j.urology.2004.10.071
- 5 O'Connor D, Green S, Higgins JPT. Chapter 5: Defining the review question and developing criteria for including studies. In: Higgins JPT, Green S. , eds. Cochrane Handbook of Systematic Reviews of Intervention. Version 5.0.1. London, UK: The Cochrane Collaboration; 2011. http://handbook-5-1.cochrane.org/index.htm#chapter_5/5_8_chapter_information.htm . Accessed January 15, 2017
- 6 Foster Jr HE, Hanno PM, Nickel JC. , et al; Interstitial Cystitis Collaborative Research Network. Effect of amitriptyline on symptoms in treatment naïve patients with interstitial cystitis/painful bladder syndrome. J Urol 2010; 183 (05) 1853-1858 . Doi: 10.1016/j.juro.2009.12.106
- 7 Warren JW, Horne LM, Hebel JR, Marvel RP, Keay SK, Chai TC. Pilot study of sequential oral antibiotics for the treatment of interstitial cystitis. J Urol 2000; 163 (06) 1685-1688 . Doi: 10.1016/S0022-5347(05)67520-9
- 8 Cartledge JJ, Davies AM, Eardley I. A randomized double-blind placebo-controlled crossover trial of the efficacy of L-arginine in the treatment of interstitial cystitis. BJU Int 2000; 85 (04) 421-426 . Doi: 10.1046/j.1464-410x.2000.00490.x
- 9 Sairanen J, Tammela TLJ, Leppilahti M. , et al. Cyclosporine A and pentosan polysulfate sodium for the treatment of interstitial cystitis: a randomized comparative study. J Urol 2005; 174 (06) 2235-2238 . Doi: 10.1097/01.ju.0000181808.45786.84
- 10 Moher D, Liberati A, Tetzlaff J, Altman DG. ; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6 (07) e1000097 . Doi: 10.1371/journal.pmed.1000097
- 11 Silva Filho CR, Saconato H, Conterno LO, Marques I, Atallah AN. Assessment of clinical trial quality and its impact on meta-analyses. Rev Saude Publica 2005; 39 (06) 865-873 . Doi: 10.1590/S0034-89102005000600001
- 12 Chen H, Wang F, Chen W. , et al. Efficacy of daily low-dose sildenafil for treating interstitial cystitis: results of a randomized, double-blind, placebo-controlled trial--treatment of interstitial cystitis/painful bladder syndrome with low-dose sildenafil. Urology 2014; 84 (01) 51-56 . Doi: 10.1016/j.urology.2014.02.050
- 13 Mulholland SG, Hanno P, Parsons CL, Sant GR, Staskin DR. Pentosan polysulfate sodium for therapy of interstitial cystitis. A double-blind placebo-controlled clinical study. Urology 1990; 35 (06) 552-558 . Doi: 10.1016/0090-4295(90)80116-5
- 14 Sant GR, Propert KJ, Hanno PM. , et al; Interstitial Cystitis Clinical Trials Group. A pilot clinical trial of oral pentosan polysulfate and oral hydroxyzine in patients with interstitial cystitis. J Urol 2003; 170 (03) 810-815 . Doi: 10.1097/01.ju.0000083020.06212.3d
- 15 Nickel JC, Herschorn S, Whitmore KE. , et al. Pentosan polysulfate sodium for treatment of interstitial cystitis/bladder pain syndrome: insights from a randomized, double-blind, placebo controlled study. J Urol 2015; 193 (03) 857-862 . Doi: 10.1016/j.juro.2014.09.036
- 16 Davis EL, El Khoudary SR, Talbott EO, Davis J, Regan LJ. Safety and efficacy of the use of intravesical and oral pentosan polysulfate sodium for interstitial cystitis: a randomized double-blind clinical trial. J Urol 2008; 179 (01) 177-185 . Doi: 10.1016/j.juro.2007.08.170