Repeated intravesical injections of autologous platelet-rich plasma (PRP) have been shown to improve symptoms in patients with interstitial cystitis/bladder pain syndrome (IC/BPS); however, there is a paucity of objective evidence of the effectiveness of this therapy. In this study, we investigated the changes in urinary markers after PRP treatment. Forty patients with IC/BPS who were refractory to conventional therapy received four injections of PRP at monthly intervals; 10 mL PRP solution with 2.5 times the peripheral blood platelet concentration was used. Urine levels of thirteen functional proteins, growth factors, and cytokines were assessed at baseline and at the 4th PRP injection. The clinical parameters included visual analog scale (VAS) pain score, daily urinary frequency, nocturia episodes, functional bladder capacity, and global response assessment (GRA). The GRA and symptom score significantly decreased post-treatment. In patients with GRA ≥ 2, the success rates at 1 month and at 3 months after the 4th PRP injection were 70.6% and 76.7%, respectively. The VAS pain score, frequency, and nocturia showed a significant decrease (all p < 0.05). Urinary levels of nerve growth factor, matrix metalloproteinase-13, and vascular endothelial growth factor significantly decreased post-treatment (p = 0.043, p = 0.02, and p = 0.000, respectively); platelet-derived growth factor-AB showed a significant increase (p = 0.004) at the 4th PRP treatment compared with baseline. In this study, repeated intravesical PRP injections provided significant symptom improvement in IC/BPS patients with concomitant changes in the related biomarker levels.Trial registration: ClinicalTrial.gov: NCT03104361; IRB: TCGH 105-48-A.

Aim: There is considerable overlap between symptoms of interstitial cystitis/painful bladder syndrome (IC/PBS) and bladder oversensitivity, thereby making it difficult to differentiate between the two based on symptoms alone. We investigated factors that could potentially be used to differentiate between IC/PBS and bladder oversensitivity in women. Materials and methods: Video-urodynamic study (VUDS) results in women with lower urinary tract symptoms (LUTS) were retrospectively analysed. Patients classified as having increased bladder sensation (IBS) were selected for analysis. A potassium chloride (KCl) test was performed and pain or urgency elicited was considered positive response. Cystoscopic hydrodistention demonstrating glomerulation was considered diagnosis of IC/PBS; otherwise bladder oversensitivity was diagnosed. LUTS, urodynamic variables and results of the KCl test were used to predict IC/PBS in these women. Results: A total of 405 women with IBS and 272 symptomatic controls with normal VUDS findings were included. Among 227 IBS patients undergoing KCl test, a positive result was found in 190 and a negative test result was found in 37. Characteristic glomerulation was noted in 170 patients, including 165 with a positive and five with a negative KCl test. We found that storage symptoms and pain had a positive predictive value of 45.3% for IC/PBS. When a CBC ≤ 350 ml was added the positive predictive value was 65% for IC/PBS. A combination of storage symptoms, a CBC ≤ 350 ml, a positive KCl test result with an increase of ≥ 2 on the visual analogue pain scale (VAS) provided 100% predictive of IC/PBS. Conclusion: A diagnosis of IC/PBS can be made without cystoscopic hydrodistention in women with increased bladder sensation, having storage symptoms, a CBC ≤ 350 ml, a positive KCl test result and a VAS score ≥ 2.

The role of urodynamic study (UDS) in diagnosis of interstitial cystitis/bladder pain syndrome (IC/BPS) remains inconclusive, nor has the predictor for a treatment success been elucidated. We evaluated the diagnostic and prognostic values of UDS in patients with IC/BPS. IC/BPS patients with complete data of a symptom assessment, video UDS, potassium chloride (KCl) test, cystoscopic hydrodistention and treatment records were reviewed retrospectively. O'Leary-Sant symptom index and problem index (ICSI, ICPI) were available in part of the patients. The associations between UDS parameters with symptom scores, KCl test result, cystoscopy findings and treatment outcome were analysed. The UDS parameters, including first sensation of filling (FSF), first desire to void (FD), strong desire to void (SD), cystometric bladder capacity (CBC), maximum flow rate (Q(max)), detrusor pressure at Q(max) (Pdet), voided volume (VV) and postvoid residual (PVR). Univariate and multivariate logistic regression analyses were used to identify the variable predicting treatment success. A total of 214 IC/BPS patients were enrolled in this study. The mean volumes at FSF, FD, SD, CBC and VV were inversely correlated with ICSI and ICPI (all p < 0.05). The patients with a positive KCl test had significantly lower mean volumes at SD, CBC, VV and lower Q(max) (all p < 0.05). Significantly lower mean volumes for FSF, FD, SD, CBC and VV were found in patients with higher grade of glomerulation under cystoscopy (all p < 0.01). The anaesthetic maximal bladder capacity (MBC) was positively correlated with FSF, FD, SD, CBC, Q(max) and VV (all p < 0.01). Female gender and the volume at SD were found to be the independent predictors for treatment outcome. Our study demonstrated that there might be a role of UDS to help in diagnosis and prognostication for IC/BPS. Future prospective investigations are warranted.

Intravesical onabotulinumtoxinA (BoNT-A) injections have been proposed to treat both overactive bladder (OAB) and interstitial cystitis/bladder pain syndrome (IC/BPS) in patients with refractory conditions. We compared adverse events (AEs) after BoNT-A treatment between IC/BPS and OAB in women. IC/BPS patients who failed conventional treatments were enrolled to receive suburothelial injections of BoNT-A (100 U) followed by hydrodistention. Age matched OAB female patients refractory to antimuscarinic agents underwent BoNT-A (100 U) injections. The bladder capacity, maximum flow rate (Qmax), post-void residual (PVR), and voiding efficiency (VE) at baseline, 3 and 6 months, and the post-treatment AEs were analyzed between groups. Finally, 89 IC/BPS and 72 OAB women were included. In the OAB group, the bladder capacity and PVR increased, and VE decreased significantly at three and six months after BoNT-A treatment. In the IC/BPS group, the Qmax increased significantly at six months. There were significant differences in changes of capacity, Qmax, PVR and VE between the two groups. Moreover, OAB patients suffered more frequently from events of hematuria, UTI, and large PVR (>200 mL), but less frequently from events of straining to void. In conclusion, OAB women had higher PVR volume and lower VE than those in IC/BPS after BoNT-A injections. These results imply that the bladder contractility of OAB patients are more susceptible to BoNT-A, which might reflect the different mechanisms of action of Botox on bladder dysfunction. Further investigations to confirm this hypothesis are warranted.

Although intravesical injection of onabotulinumtoxinA (BoNT-A) has been proved promising in treating patients with interstitial cystitis/bladder pain syndrome (IC/BPS), what kind of patients that may benefit from this treatment remains unclear. This study investigated the predictors for a successful treatment outcome. Patients with IC/BPS who failed conventional treatments were enrolled to receive intravesical injection of 100 U of BoNT-A immediately followed by hydrodistention. Variables such as O’Leary-Sant symptom and problem indexes (ICSI and ICPI), pain visual analogue scale (VAS), functional bladder capacity (FBC), voiding diary, and urodynamic parameters were measured at baseline and six months after treatment. A global response assessment (GRA) ≥ 2 at six months was defined as successful. There were101 patients enrolled. Significant improvements were observed in mean ICSI, ICPI, OSS (ICSI + ICPI), pain VAS, FBC, frequency, nocturia and GRA at six months after BoNT-A injections (all p < 0.05). The successful rate at six months was 46/101 (45.54%). Multivariate logistic regression revealed the baseline ICSI (odds ratio = 0.770, 95% confidence interval = 0.601–0.989) was the only predictor for a treatment outcome. ICSI ≥ 12 was the most predictive cutoff value for a treatment failure, with a ROC area of 0.70 (sensitivity = 69.1%, specificity = 60.9%).