Several established and novel treatments have been developed to treat interstitial cystitis/bladder pain syndrome (IC/BPS). Although preliminary results seem promising, the actual mechanisms have not been explored and successful outcome was limited in individual bladder therapy. This study investigated the clinical results and the changes of urinary biomarkers among different established and novel bladder therapy for IC/BPS.

A total of 148 patients with IC/BPS received four monthly intravesical platelet-rich plasma (PRP) injection (n=45), intravesical Botulinum toxin A (BoNT-A) 100U injection (n=30), 9 intravesical hyaluronic acid (HA) instillations (n=23), and 4 sessions of low energy shock wave (LESW) bladder therapy (n=50). The changes of symptom score, voiding diary, and uroflowmetry measurements were compared among different groups. Thirteen urine biomarkers were assayed. In addition, 30 women without lower urinary tract dysfunction served as controls for the normal levels of urinary biomarkers.

Significant improvements of IC symptoms, bladder pain score were noted in patients receiving PRP, BoNT-A, and LESW therapy (p=0.002). Decrease of frequency was noted only in PRP and BoNT-A groups. However, the changes of clinical variables from baseline to post-treatment were not significant among subgroups (Table 1). The changes of urinary biomarkers from baseline to post-treatment show significant decrease in total antioxidant capacity (TAC) in the PRP and BoNT-A subgroups, but not in the HA and LESW subgroups. Decrease of 8-OHdG was noted only after BoNT-A treatment, but not found in the other subgroups. Compared with the controls, the urinary biomarkers such as MCP-1, TNF-α, 8-OHdG, 8-isoprostane, and TAC after treatment were still significantly higher than the controls (Table 2).

Among the four established and novel bladder therapy for patients with IC/BPS, limited inflammatory and oxidative stress urinary biomarkers were noted after a standard treatment course. Significant decrease in TAC was noted only in PRP and BoNT-A subgroups, and decrease of 8-OHdG was noted only after BoNT-A treatment. Compared with the controls, the urinary biomarkers such as MCP-1, TNF-α, 8-OHdG, 8-isoprostane, and TAC after treatment were still significantly higher than the controls, indicating the bladder inflammation and oxidative stress do not have significant improvement after the bladder therapy. Continuing bladder therapy should be proceeded if the bladder symptoms persist, and the urinary biomarker levels might be used to monitor the true bladder condition after treatment.

Although the clinical symptoms of patients with IC/BPS showed significant improvement, the changes of urinary biomarkers were limited after PRP, BoNT-A, HA or LESW bladder therapy, suggesting the bladder inflammation was not adequately eradicated by a traditional treatment course of the established or novel bladder therapy. More treatment is needed in order to achieve a clinically significant improvement of bladder condition.