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NEUROUROLOGY
& FEMALE UROLOGY
Dyspareunia
response in patients with interstitial cystitis treated with intravesical
lidocaine, bicarbonate, and heparin
Welk BK, Teichman JM
Division of Urology, Providence Healthcare, Vancouver, British Columbia,
Canada
Urology. 2008; 71: 67-70
- Objectives:
To test the dyspareunia response of patients with interstitial cystitis/painful
bladder syndrome treated with an intravesical therapeutic solution of
lidocaine, heparin, and sodium bicarbonate.
-
Methods:
We studied consecutive patients with interstitial cystitis/painful bladder
syndrome who were sexually active and were treated with an intravesical
therapeutic solution. All patients provided their medical history, underwent
a physical examination, and completed the Pelvic Pain Urgency Frequency
symptom scale, voiding diary, and the pain domain (questions 17 to 19)
of the Female Sexual Function Index before and after therapy. The patients
were treated with intravesical instillations three times weekly for
3 weeks. The patients returned for follow-up 3 weeks later. The patients
rated their response using a Patient Objective Rating of Improvement
of Symptom scale.
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Results:
A total of 23 patients (mean age 38 years) were included in this study.
Of the 23 patients, 15 (65%) reported improvements of greater than 50%
on the Patient Objective Rating of Improvement of Symptom scale. Before
and after instillation, nocturia was 4 +/- 2 versus 2 +/- 1 (P <
0.001), the voided volume was 98 +/- 59 mL versus 169 +/- 80 mL (P <
0.001), the Pelvic Pain Urgency Frequency score was 21 +/- 6 versus
15 +/- 6 (P < 0.001), and the Female Sexual Function Index pain domain
score was 1.9 +/- 0.9 versus 3.7 +/- 1.6 (P < 0.001), respectively.
Of the 23 patients, 13 (57%) reported resolution of dyspareunia. Of
the 13 patients with bladder tenderness only versus the 7 with multiple
tender locations on the vaginal examination, 11 (85%) versus 2 (29%)
had resolution of dyspareunia (P < 0.01) and 12 (92%) versus 2 (29%)
had successful overall outcomes (P < 0.01).
-
Conclusions:
The results of this study have demonstrated that an intravesical therapeutic
solution provides relief of voiding symptoms, pain, and dyspareunia
in patients with interstitial cystitis/painful bladder syndrome. A randomized,
prospective trial is warranted.
- Editorial
Comment
The authors analyzed the rate of dyspareunia in a female patient population
diagnosed with interstitial cystitis and subsequently treated with intravesical
instillations of a lidocaine/sodium bicarbonate/heparin solution three
times a week for three weeks in a row. The therapy seemed to have a
certain level of durability in that a definite percentage of patients
were asymptomatic for three weeks. The authors noted that patients had
a much higher response rate if prior to treatment they were plagued
with bladder tenderness only on physical examination as opposed to a
diffusely painful vagina on digital palpation.
This interesting paper highlights the association of sexual problems
in patients with interstitial cystitis. It is heartening that those
patients who had basically only bladder tenderness on vaginal palpation
experienced an 85% resolution of their dyspareunia with this instillation
therapy. The authors note that alkalinizing the lidocaine will allow
it to have a greater penetration of bladder epithelium. Alkalinization
of lidocaine has also been reported to diminish pain during interdermal
injections with local infiltrated anesthesia. I found it noteworthy
that the total solution instilled in the bladder was only 14 cc while
the lidocaine gel instilled in the urethra to anesthetize prior to catheterization
was 10 cc in itself. The logistical efficacy of intravesical therapies
for patients in the office cannot be understated. Those with an interest
in this specific population and therapy should definitely review the
article upon which this report is based (1).
Reference
1. Parsons CL: Successful downregulation of bladder sensory nerves with
combination of heparin and alkalinized lidocaine in patients with interstitial
cystitis. Urology. 2005; 65: 45-8.
Steven
P. Petrou, M.D
Associate Professor of Urology
Chief of Surgery, St. Luke’s Hospital
Associate Dean, Mayo School of Graduate Medical Education
Jacksonville, Florida, USA
E-mail: petrou.steven@mayo.edu |