Novel treatments of interstitial cystitis/bladder pain syndrome based on pathophysiology

Interstitial cystitis/bladder pain syndrome is characterized by bladder pain associated with urgency, frequency, nocturia, dysuria and sterile urine. Recent studies revealed that these bladder dysfunctions could originate from chronic inflammation or urothelial insult and proceed to a cascade of tissue reactions, which finally ascends to the CNS. The principles for treatment of interstitial cystitis/bladder pain syndrome are based on controlling the dysfunctional epithelium by continual replenishment of the glycosaminoglycan layer, inhibiting neurological hyperactivity by administration of amitriptyline or imipramine, suppression of allergies with antihistamines, and pain control with nonsteroidal anti-inflammatory drugs, COX-2 inhibitors or tranquilizers. Intravesical treatment with heparin, hyaluronic acid, chondroitin sulfate, Bacillus Calmette–Guérin, dimethylsulfoxide, resiniferatoxin, or botulinum toxin A has shown early effectiveness in some patients. Surgical treatment should be reserved for those who have no response to medical therapy.