Skip to main content
SpringerLink
Log in
Book cover

Urological and Gynaecological Chronic Pelvic Pain pp 227–236Cite as

Immunomodulators for Interstitial Cystitis/Bladder Pain Syndrome

  • Chapter
  • First Online:

  • 917 Accesses

Abstract

This chapter discusses systemic medicines that modulate the immune system, with the rationale that some cases of IC/BPS involve an inflammatory pathophysiology. Due to the significant risks of systemic immune suppression, it is essential to select patients who have the relevant pathophysiology. With current technology, this is best accomplished by cystoscopy and bladder biopsy. It also is essential to try less risky treatments first, and offer immunomodulation only when the less risky treatments fail. Of all immunomodulators previously studied for IC/BPS, only two are discussed in the American Urological Association guideline. First, the guideline recommends that long-term systemic glucocorticoids not be used. Second, the guideline lists cyclosporine A as a fifth tier treatment option (with the sixth and final tier being major surgery). This chapter summarizes the prior literature on immunomodulators previously investigated for IC/BPS and describes practical considerations for clinical use of cyclosporine A.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Hunner GL. A rare type of bladder ulcer in women: report of cases. Boston Med Surg J. 1915;172:660–4.

    Article  Google Scholar 

  2. Hunner GL. Elusive ulcer of the bladder. Further notes on a rare type of bladder ulcer, with a report of twenty-five cases. Am J Obstet. 1918;78:374.

    Google Scholar 

  3. Hunner GL. A rare type of bladder ulcer. Further notes, with a report of eighteen cases. JAMA. 1918;70:203–12.

    Article  Google Scholar 

  4. Burford EH, Burford CE. Hunner ulcer of the bladder: a report of 187 cases. J Urol. 1958;79:952–5.

    CAS  PubMed  Google Scholar 

  5. Walsh A. Historical perspectives. In: Hanno PM, Staskin DR, Krane RJ, Wein AJ, editors. Interstitial cystitis. New York, NY: Springer; 1990. p. 17–21.

    Chapter  Google Scholar 

  6. Walsh A. Interstitial cystitis. In: Harrison JH, Gittes RF, Perlmutter AD, Stamey TA, Walsh PC, editors. Campbell’s urology. 4th ed. Philadelphia, PA: WB Saunders; 1978. p. 693–707.

    Google Scholar 

  7. Hand JR. Interstitial cystitis; report of 223 cases (204 women and 19 men). J Urol. 1949;61:291–310.

    CAS  PubMed  Google Scholar 

  8. Fall M, Johansson SL, Aldenborg F. Chronic interstitial cystitis: a heterogeneous syndrome. J Urol. 1987;137:35–8.

    CAS  PubMed  Google Scholar 

  9. Johansson SL, Fall M. Clinical features and spectrum of light microscopic changes in interstitial cystitis. J Urol. 1990;143:1118–24.

    CAS  PubMed  Google Scholar 

  10. van de Merwe JP, Nordling J, Bouchelouche P, Bouchelouche K, Cervigni M, Daha LK, Elneil S, Fall M, Hohlbrugger G, Irwin P, Mortensen S, van Ophoven A, Osborne JL, Peeker R, Richter B, Riedl C, Sairanen J, Tinzl M, Wyndaele JJ. Diagnostic criteria, classification, and nomenclature for painful bladder syndrome/interstitial cystitis: an ESSIC proposal. Eur Urol. 2008;53:60–7.

    Article  PubMed  Google Scholar 

  11. Hanno PM, Burks DA, Clemens JQ, Dmochowski RR, Erickson D, Fitzgerald MP, Forrest JB, Gordon B, Gray M, Mayer RD, Newman D, Nyberg Jr L, Payne CK, Wesselmann U, Faraday MM, Interstitial Cystitis Guidelines Panel of the American Urological Association Education and Research Inc. AUA guideline for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome. J Urol. 2011;185:2162–70.

    Article  PubMed  Google Scholar 

  12. Hanno PM, Erickson D, Moldwin R, Faraday MM. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome: AUA guideline amendment. J Urol. 2015;193:1545–53.

    Article  PubMed  Google Scholar 

  13. Berry SH, Elliott MN, Suttorp M, Bogart LM, Stoto MA, Eggers P, Nyberg L, Clemens JQ. Prevalence of symptoms of bladder pain syndrome/interstitial cystitis among adult females in the United States. J Urol. 2011;186:540–4.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Wyndaele JJ, Van Dyck J, Toussaint N. Cystoscopy and bladder biopsies in patients with bladder pain syndrome carried out following ESSIC guidelines. Scand J Urol Nephrol. 2009;43:471–5.

    Article  PubMed  Google Scholar 

  15. Erickson DR, Tomaszewski JE, Kunselman AR, Setter CM, Peters KM, Rovner ES, Demers LM, Wheeler MA, Keay SK. Urine markers do not predict biopsy findings or presence of bladder ulcers in interstitial cystitis/painful bladder syndrome. J Urol. 2008;179:1850–6.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Andersson K-E, Hedlund H. Pharmacotherapeutic goals in interstitial cystitis. In: Hanno PM, Staskin DR, Krane RJ, Wein AJ, editors. Interstitial cystitis. New York: Springer; 1990. p. 135–45.

    Chapter  Google Scholar 

  17. Cox M, Klutke JJ, Klutke CG. Assessment of patient outcomes following submucosal injection of triamcinolone for treatment of Hunner's ulcer subtype interstitial cystitis. Can J Urol. 2009;16:4536–40.

    PubMed  Google Scholar 

  18. Soucy F, Gregoire M. Efficacy of prednisone for severe refractory ulcerative interstitial cystitis. J Urol. 2005;173:841–3.

    Article  CAS  PubMed  Google Scholar 

  19. Hosseini A, Ehren I, Wiklund NP. Nitric oxide as an objective marker for evaluation of treatment response in patients with classic interstitial cystitis. J Urol. 2004;172:2261–5.

    Article  CAS  PubMed  Google Scholar 

  20. Oravisto KJ, Alfthan OS. Treatment of interstitial cystitis with immunosuppression and chloroquine derivatives. Eur Urol. 1976;2:82–4.

    CAS  PubMed  Google Scholar 

  21. Moran PA, Dwyer PL, Carey MP, Maher CF, Radford NJ. Oral methotrexate in the management of refractory interstitial cystitis. Aust N Z J Obstet Gynaecol. 1999;39:468–71.

    Article  CAS  PubMed  Google Scholar 

  22. Yang CC, Burks DA, Propert KJ, Mayer RD, Peters KM, Nickel JC, Payne CK, FitzGerald MP, Hanno PM, Chai TC, Kreder KJ, Lukacz ES, Foster HE, Cen L, Landis JR, Kusek JW, Nyberg LM, Interstitial Cystitis Collaborative Research Network. Early termination of a trial of mycophenolate mofetil for treatment of interstitial cystitis/painful bladder syndrome: lessons learned. J Urol. 2011;185:901–6.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Bosch PC. A randomized, double-blind, placebo controlled trial of adalimumab for interstitial cystitis/bladder pain syndrome. J Urol. 2014;191:77–82.

    Article  CAS  PubMed  Google Scholar 

  24. Foster Jr HE, Hanno PM, Nickel JC, Payne CK, Mayer RD, Burks DA, Yang CC, Chai TC, Kreder KJ, Peters KM, Lukacz ES, FitzGerald MP, Cen L, Landis JR, Propert KJ, Yang W, Kusek JW, Nyberg LM, Interstitial Cystitis Collaborative Research Network. Effect of amitriptyline on symptoms in treatment naïve patients with interstitial cystitis/painful bladder syndrome. J Urol. 2010;183:1853–8.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Forsell T, Ruutu M, Isoniemi H, Ahonen J, Alfthan O. Cyclosporine in severe interstitial cystitis. J Urol. 1996;155:1591–3.

    Article  CAS  PubMed  Google Scholar 

  26. Sairanen J, Forsell T, Ruutu M. Long-term outcome of patients with interstitial cystitis treated with low dose cyclosporine A. J Urol. 2004;171:2138–41.

    Article  CAS  PubMed  Google Scholar 

  27. Sairanen J, Tammela TL, Leppilahti M, Multanen M, Paananen I, Lehtoranta K, Ruutu M. Cyclosporine A and pentosan polysulfate sodium for the treatment of interstitial cystitis: a randomized comparative study. J Urol. 2005;174:2235–8.

    Article  CAS  PubMed  Google Scholar 

  28. Forrest JB, Payne CK, Erickson DR. Cyclosporine A for refractory interstitial cystitis/bladder pain syndrome: experience of 3 tertiary centers. J Urol. 2012;188:1186–91.

    Article  CAS  PubMed  Google Scholar 

  29. Ehrén I, Hallén Grufman K, Vrba M, Sundelin R, Lafolie P. Nitric oxide as a marker for evaluation of treatment effect of cyclosporine A in patients with bladder pain syndrome/interstitial cystitis type 3C. Scand J Urol. 2013;47:503–8.

    Article  PubMed  Google Scholar 

  30. Sairanen J, Tammela TL, Ruutu M. Tacrolimus in the treatment of bladder pain syndrome/interstitial cystitis (BPS/IC): a pilot study. Eur Urol Suppl. 2010;9(2):212.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, University of Kentucky College of Medicine, 800 Rose Street, MS-275, Lexington, KY, 40536-0298, USA

    Deborah R. Erickson

  2. Department of Pharmacology and Nutritional Sciences, University of Kentucky College of Medicine, 800 Rose Street, MS-309, Lexington, KY, 40536-0298, USA

    Eric M. Blalock

Authors
  1. Deborah R. Erickson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eric M. Blalock
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Deborah R. Erickson .

Editor information

Editors and Affiliations

  1. The Arthur Smith Institute for Urology, Hofstra Northwell School of Medicine, Northwell Health, Lake Success, New York, USA

    Robert M. Moldwin

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Erickson, D.R., Blalock, E.M. (2017). Immunomodulators for Interstitial Cystitis/Bladder Pain Syndrome. In: Moldwin, R. (eds) Urological and Gynaecological Chronic Pelvic Pain. Springer, Cham. https://doi.org/10.1007/978-3-319-48464-8_15

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-48464-8_15

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-48462-4

  • Online ISBN: 978-3-319-48464-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation