Efficacy of Interstitial Cystitis Treatments: A Review

Abstract

Objective Interstitial cystitis (IC) is a chronic clinical condition known for more than a century. Its pathophysiology remains largely unclear. No universally-effective treatment exists, and many patients do not respond to available therapies. There is no evidence-based algorithm and no standard therapy for IC. The aims of this article are to review the available treatment options and to evaluate the degree of evidence regarding their clinical efficacy. Materials and Methods We reviewed English language publications on IC from January 1966 to August 2005 listed in MEDLINE, and we selected clinical studies reporting on IC treatment. For each treatment type, we give the level of evidence and the recommendation grade according to the “Oxford University Program for Evidence-based Studies”. Results Most articles were retrospective, non-randomized, uncontrolled studies with small numbers of patients. Twenty articles provided high-level evidence. Three therapies are supported by a high level of evidence: oral Cimetidine and Amitriptyline, and one intravesical agent, Dimethylsulfoxide (DMSO). Reports on surgical treatments were only open investigations. Conclusion IC treatment is complex and controversial because of the disease's unidentified, formal etiology. We proposed an evidence-based algorithm that might be helpful when counseling IC patients regarding treatment options and expectations from each therapy.