Interstitial Cystitis When Intravesical Therapy Has Not Achieved Adequate Symptom Control

For patients with interstitial cystitis whose initial intravesical-based treatment course has not produced the expected improvement, a structured next-line protocol targeting urinary frequency is available.

Previous Treatment — Failure Condition

This protocol applies when intravesical dimethyl sulfoxide, intravesical heparin, or the combination of oral and intravesical pentosan polysulfate sodium has not led to improvement in the O'Leary-Sant Symptom and Problem Index score, has not relieved bladder pain, and has not reduced urinary urgency by 8 weeks.

Clinical Goal at This Stage

The primary target is reduction in urinary frequency.

Next-Line Approach

This protocol involves a nerve stimulation–based intervention. The specific modality and the full clinical decision pathway are detailed in the complete structured regimen.

Instant Access to Structured Evidence-Based Regimens

References

A small randomized crossover trial demonstrated better symptom relief with pudendal nerve stimulation than with sacral nerve stimulation.
Sacral nerve stimulation may be effective in addressing the frequency associated with interstitial cystitis/painful bladder syndrome, but not for pain relief, and it is not FDA-approved for this purpose.

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