Introduction
For many clinicians, the treatment of interstitial cystitis/painful bladder syndrome (IC/PBS) has become a lesson in learning to treat chronic pain. It is not a cancer that can be cured, nor a stone to be extracted. It is a painful triad of pelvic or bladder pain accompanied by urinary urgency and frequency. There is no perfect test to establish its diagnosis; rather, it is a diagnosis of exclusion. This is a chronic, frustrating disease which often leads patients to “doctor shop” and receive inadequate treatment for their chronic pain. Clinicians are equally frustrated due to the lack of effective treatment options for their patients.
A variety of treatments have been utilized to improve symptoms in IC/PBS patients. These include dietary modification, pelvic floor physical therapy, lifestyle interventions, oral medication, intravesical instillation therapy, neuromodulation, and surgical intervention. No single treatment has emerged as highly effective in all cases. Two frequently utilized therapies are oral pentosan polysulfate and intravesical instillations. We have reviewed the medical literature to evaluate the existing evidence to support these therapies.
A Medline literature search was performed for the period 1980–2008 to identify all meta-analyses and systematic reviews related to the use of pentosan polysulfate for IC/PBS. These were identified by using a keyword search for “interstitial cystitis” and limiting the search to meta-analyses and systematic reviews. All abstracts identified by this process were then manually reviewed to identify publications which addressed the efficacy of pentosan polysulfate.
Clinical question 13.1
Is oral pentosan polysulfate effective in reducing IC/PBS symptoms?
The evidence
Dimitrakov and co-workers conducted a systematic review of the literature through 2007 to assess the efficacy of various pharmacological approaches to IC/PBS [1]. Included in this analysis were six randomized controlled trials and one meta-analysis which compared oral pentosan polysulfate to placebo. Treatment duration ranged from 12 to 24 weeks. The reported overall response rate varied between 15% and 67% in individual trials. Pooled analysis suggested benefit of active treatment compared with placebo, with a relative risk of 1.78 for patient-reported “global improvement” in symptoms (95% confidence interval 1.34–2.35) (Table 13.1). Improvements in pain, frequency, urgency, and Interstitial Cystitis Symptom Index scores were also reported, although many of these improvements did not reach statistical significance.
Table 13.1 Symptom response to pentosan polysufate therapy. Adapted from Dimitrakov et al. [1]
| Outcome | Standardized mean difference (95% CI)* |
| Effect on patient-reported pain | |
| Mullholland et al. [3] | –0.15 (–0.53 to 0.22) |
| Parsons & Mullholland [4] | –0.74 (–1.34 to –0.14) |
| Sairanein et al. [5] | –0.48 (–1.01 to 0.04) |
| Sant et al. [6] | –0.11 (–0.62 to 0.40) |
| Effect on patient-reported urinary frequency |
