The following drugs can be used: amitriptyline, an oral tricyclic antidepressant, (75 mg per day before sleep, for a period of at least 8 weeks) in conservative treatment; anti-cholinergic for patients with severe impingement symptoms; pentosan polysulfate (400 mg 2 per day, times a day) for patients with a long history of the disease. We do combine intravesical diluted heparin with lidocaine solution (lidocaine solution of 2 % is diluted with 10 000 IU heparin solution 50 cc NaCl %) for patients with more severe pain. We have observed that symptoms are relieved after this treatment, even for a short period of time. As mentioned above, sometimes we do combine the first and second line treatment options in selected cases. In our experience, the combination is more effective in these cases.

We proceed with cystoscopy and hydro-distension under general anesthesia as a minimally invasive treatment. As shown in the literature, hydro-distension is useful in many cases [3]. In our practice, we do not use hydro-distension alone, but we combine it with medical conservative treatment as necessary. Efficiency takes an average of 3 months.

A more radical treatment can be considered for patients who are unresponsive to any treatment, whose quality of life is severely impaired and whose anesthetic bladder capacity has seriously contracted organically. In these cases cystectomy and urinary diversion represents a treatment modality. Despite being quite aggressive, it can ultimately result improvement of the quality of life, as symptoms can disappeared in selected patients and those in the “terminal” stage.