Intravesical therapies for intestitial cystitis

Intravesically applied medications have the benefit of establishing high co ncentrations of a therapeutic agent at the intended target tissue along wit h a low risk for systemic side effects. Pentosanpolysulfate is frequently a pplied for this purpose and was shown to significantly reduce nycturia whil e frequency during the day remained unaffected in a controlled study. Hepar in reduced nycturia in an open prospective protocol as well. For heparin th e maximal onset of a therapeutic effect is often observed as late as 4-6 mo nths after initiation of treatment. Heparin as well as pentosanpolysulfate cause practically no side effects. Dimethylsulfoxide (DMSO),when instilled intravesically, decreases symptoms up to 50-70% for an effective period of 1-2 months. An irritating but harml ess side effect of DMSO is the development of a striking garlic-like odor. BCG improved symptoms in 10 of 15 patients after 8 months and in 8 of 15 pa tients after 24 months. No patient with an initial bladder capacity below 1 75 cc benefited from BCG instillations. Discomfort in the bladder region wa s noted as a frequent side effect. Instillations of clorpactin WCS 90 are p ainful and can thus only be applied under anesthesia. Success rates range b etween 50-70% and last for 6-12 months.