Bladder Instillation Patterns in a Cohort of Women With Interstitial Cystitis/Bladder Pain Syndrome

Author:

Niino Clarissa A.1,Tholemeier Lauren N.1,Bresee Catherine2,De Hoedt Amanda M.3,Barbour Kamil E.4,Kim Jayoung5,Freedland Stephen J.,Anger Jennifer T.6

Affiliation:

1. Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA

2. Biostatistics Core at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA

3. Durham Veterans Affairs Health System, Durham, NC

4. Centers for Disease Control and Prevention, Atlanta, GA

5. Surgery

6. Department of Urology, UC San Diego Medical Center, La Jolla, CA.

Abstract

Importance Interstitial cystitis/bladder pain syndrome (IC/BPS) is a prevalent disorder known to be notoriously difficult to treat. Objective The aim of the study was to determine intravesical instillation patterns among women receiving treatment for IC/BPS. Study Design This was a retrospective claims-based analysis using the Veterans Affairs Informatics and Computing Infrastructure. Females with an International Classification of Diseases, Ninth Revision, diagnosis of IC/BPS (595.1) were sampled randomly. Patients were considered to have IC/BPS if they had 2 visits with bladder pain in the absence of a positive urine culture 6 weeks or more apart or a history of bladder pain with another visit for bladder pain. Dates of intravesical instillations were extracted. A “course” of instillations was defined as 1 or more instillations made with less than 21 days between visits. Results We identified 641 women with a confirmed diagnosis of IC/BPS, 78 of whom underwent a total of 344 intravesical instillations. On average, each woman had 1.5 ± 0.8 courses between October 2004 and July 2016. Each course was an average of 3.1 ± 2.6 instillations. Fifty-five percent of courses consisted of 1 instillation. Only 22% of courses had 6 or more instillations, the number typically recommended to achieve clinical response. Each instillation within a course was an average of 9.4 ± 4.0 days apart. Most instillations (77%) involved a cocktail of 2 or more drugs. Conclusions In our cohort, few women with IC/BPS received a recommended treatment course of 6 weekly instillations, with most receiving only 1 per course. Future studies are needed to determine whether instillation courses were altered from the guidelines due to health care provider practice patterns, early improvement, or poor tolerance of instillations.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Urology,Obstetrics and Gynecology,Surgery

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