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Intra-vesical therapy (bladder instillation therapy) for ic
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Intra-vesical Therapy (Bladder Instillation Therapy) for IC
The management of interstitial cystitis (IC) can be very challenging for
both the patient and the Urologist. However, effective treatments for IC
There are various modalities for treatment of IC, one of them is intra-
vesical therapy (bladder instillation). Intra-vesical therapy (IVT) is
becoming one of the most popular, and probably, the most effective
The symptoms of IC can be controlled with bladder installation therapy,
when a combination of medication in a liquid solution is flushed into the
bladder. The bladder is then filled with this liquid that is held for different
periods of time before being emptied. The procedure is quick and needs
to be repeated, initially on a weekly basis.
The usual regimen for instillation is weekly for 4-6 weeks, then two
weekly for a period of time. Once symptoms under control, a
maintenance regimen is tailored to the need of that specific patient
ranging from once every three weeks to once every two months. Not all
patients need to go on a maintenance protocol and some IC patients can
have a relatively prolonged remission with this therapy.
Various medications has been tried for bladder instillation like, DMSO
(dimethyl sulfoxide), Heparin, Sodium Hyaluronate (Cystistat
Bacillus Calmette-Guérin (BCG), L Arginine, Oxybutynin ,
Capsaicin and Resiniferatoxin and more recently Chondroitin
One of the most popular theories in the aetiology of IC is a defect or
damage to the GAG layer (glycosaminoglycan), which is the protective
layer of the inside of the bladder. Therefore, the aim of instillation
therapy is to replace or replenish this GAG layer and reduce the
permeability of the lining of the bladder to potassium ions, believed to
The advantages of instillation therapy are the following:
• High concentration of drug at target location • Fast symptoms relief • High response rate • Minimum side effects • Out patient treatment • Potential for self-instillation
Currently the most popular IVT is the Sterile Sodium Hyaluronic acid
(Cystistat®). Dimethyl Sulfoxide (DMSO) is also widely used. Other
GAG layers replenishing agent is Chondrotin sulfate which is available as
Uracyst®-S. Some centres use a combination of heparin, hydrocortisone,
bicarbonate and local anaesthetic solution (Cocktail Therapy).
Although instillation therapy is generally considered to have minimal side
effects, a certain degree of patient cooperation is required and hyper-
sensitivity reactions are possible. Another disadvantage is the need for
catheterisation for each session of treatment with risk of infection and
Finally, instillation therapy is generally very well tolerated and the group
of patients who respond appears to be very satisfied with its results.
Mr Zaki Almallah MD FRCS (Urol)
Parsons CL in Weiss, George and O’Reilly, Comprehensive Urology, Mosby 2001.
Kurth KH in Interstitial Cystitis, Ergbnisse Verlag 2004.
Available online at www.sciencedirect.comThe Veterinary Journal xxx (2007) xxx–xxxUse of domperidone in the treatment of canine visceral leishmaniasis:P. Go´mez-Ochoa a,*, J.A. Castillo a, M. Gasco´n a, J.J. Zarate a, F. Alvarez b, C.G. Couto ba Department of Animal Pathology, Veterinary Faculty of Zaragoza, c/ Miguel Servet 177, CP 50013 Zaragoza, Spainb Veterinary Teaching Hospital ,D
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