Interstitial Cystitis When Initial Oral Therapy Has Not Achieved Adequate Symptom Control
This protocol addresses patients with interstitial cystitis (painful bladder syndrome) who have completed an initial course of oral therapy but have not achieved the expected reduction in suprapubic pelvic pain, urinary urgency, urinary frequency, and nocturia by 4 months — indicating the need for escalation to the next treatment line.
The prior line included oral agents such as pentosan polysulfate sodium (Elmiron), hydroxyzine (Vistaril), amitriptyline, nortriptyline (Pamelor), and/or cimetidine (Tagamet), along with dietary trigger avoidance. The target of meaningful reduction in pelvic pain, urinary urgency, frequency, and nocturia at 4 months was not achieved, prompting escalation to this protocol.
The aim is improvement in the O'Leary-Sant Symptom and Problem Index score, relief of bladder pain, and reduction in urinary urgency — assessed at 8 weeks.
This next-line approach moves to intravesical instillation — therapy delivered directly into the bladder. More than one intravesical option is covered in the structured protocol; the complete regimen, sequence, and selection criteria are available via the link below.