Dyspareunia response in patients with interstitial cystitis treated with intravesical lidocaine, bicarbonate, and heparin

OBJECTIVES To test the dyspareunia response of patients with interstitial cystitis/painful bladder syndrome treated with an intravesical therapeutic solution of lidocaine, heparin, and sodium bicarbonate. METHODS We studied consecutive patients with interstitial cystitis/painful bladder syndrome who were sexually active and were treated with an intravesical therapeutic solution. All patients provided their medical history, underwent a physical examination, and completed the Pelvic Pain Urgency Frequency symptom scale, voiding diary, and the pain domain (questions 17 to 19) of the Female Sexual Function Index before and after therapy. The patients were treated with intravesical instillations three times weekly for 3 weeks. The patients returned for follow-up 3 weeks later. The patients rated their response using a Patient Objective Rating of Improvement of Symptom scale. RESULTS A total of 23 patients (mean age 38 years) were included in this study. Of the 23 patients, 15 (65%) reported improvements of greater than 50% on the Patient Objective Rating of Improvement of Symptom scale. Before and after instillation, nocturia was 4 +/- 2 versus 2 +/- 1 (P <0.001), the voided volume was 98 +/- 59 mL versus 169 +/- 80 mL (P <0.001), the Pelvic Pain Urgency Frequency score was 21 +/- 6 versus 15 +/- 6 (P <0.001), and the Female Sexual Function Index pain domain score was 1.9 +/- 0.9 versus 3.7 +/- 1.6 (P <0.001), respectively. Of the 23 patients, 13 (57%) reported resolution of dyspareunia. Of the 13 patients with bladder tenderness only versus the 7 with multiple tender locations on the vaginal examination, 11 (85%) versus 2 (29%) had resolution of dyspareunia (P <0.01) and 12 (92%) versus 2 (29%) had successful overall outcomes (P <0.01). CONCLUSIONS The results of this study have demonstrated that an intravesical therapeutic solution provides relief of voiding symptoms, pain, and dyspareunia in patients with interstitial cystitis/painful bladder syndrome. A randomized, prospective trial is warranted.