INTRAVESICAL BACILLUS CALMETTE-GUERIN AND DIMETHYL SULFOXIDE FOR TREATMENT OF CLASSIC AND NONULCER INTERSTITIAL CYSTITIS:: A PROSPECTIVE, RANDOMIZED DOUBLE-BLIND STUDY

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Dec 2000INTRAVESICAL BACILLUS CALMETTE-GUERIN AND DIMETHYL SULFOXIDE FOR TREATMENT OF CLASSIC AND NONULCER INTERSTITIAL CYSTITIS:: A PROSPECTIVE, RANDOMIZED DOUBLE-BLIND STUDY RALPH PEEKER, MOHAMMAD-ALI HAGHSHENO, STEN HOLMÄNG, and MAGNUS FALL RALPH PEEKERRALPH PEEKER , MOHAMMAD-ALI HAGHSHENOMOHAMMAD-ALI HAGHSHENO , STEN HOLMÄNGSTEN HOLMÄNG , and MAGNUS FALLMAGNUS FALL View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)66916-9AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We conducted a prospective, double-blind study with a crossover design of intravesical bacillus Calmette-Guerin (BCG) and dimethyl sulfoxide to determine whether patients with classic and nonulcer interstitial cystitis, respectively, might benefit from either regimen. Materials and Methods: A total of 21 patients, including 11 with classic and 10 with nonulcer interstitial cystitis, randomly underwent treatments with intravesical BCG or dimethyl sulfoxide and, if not improved, were treated with the other substance after a washout period. All 21 patients were evaluated with symptom questionnaires, including a visual analog pain scale and voiding diaries. Results: Regardless of regimen, there was no improvement in maximal functional capacity. There was a reduction in urinary frequency following dimethyl sulfoxide treatment but only in the classic subtype (p <0.05), whereas no reduction was seen following BCG in either subtype. A substantial pain decrease was noted in classic (p <0.05) as well as nonulcer (p <0.05) interstitial cystitis following dimethyl sulfoxide. Conclusions: Intravesical BCG has been presented as a promising new option for treatment of interstitial cystitis. We failed to demonstrate benefit from this treatment. Dimethyl sulfoxide had no positive effect on maximal functional capacity but resulted in a significant reduction in pain and urinary frequency, although only in patients with classic interstitial cystitis. References 1 : A rare type of bladder ulcer in women; report of cases. Boston Med Surg J1915; 172: 660. Google Scholar 2 : Elusive ulcer of the bladder: further notes on a rare type of bladder ulcer with report of 25 cases. Am J Obstet1918; 78: 374. Google Scholar 3 : Interstitial cystitis: report of 223 cases (204 women and 19 men). J Urol1949; 61: 291. Link, Google Scholar 4 : Interstitial cystitis: early diagnosis, pathology and treatment. Urology1978; 12: 381. Google Scholar 5 : The natural history of interstitial cystitis: a survey of 374 patients. J Urol1993; 149: 465. Link, Google Scholar 6 : Interstitial cystitis: a women's health perspective. In: Interstitial Cystitis. Edited by . Philadelphia: Lippincott-Raven1997: 257. chapt. 32. Google Scholar 7 : Chronic interstitial cystitis: a heterogeneous syndrome. J Urol1987; 137: 35. Link, Google Scholar 8 : Discrimination between the ulcerous and the nonulcerous forms of interstitial cystitis by noninvasive findings. J Urol1996; 155: 87. Link, Google Scholar 9 : Intravesical hyaluronic acid in the treatment of refractory interstitial cystitis. J Urol1996; 156: 45. Link, Google Scholar 10 : Dimethyl sulfone (DMSO2) in the treatment of interstitial cystitis. Urol Clin North Am1994; 21: 85. Google Scholar 11 : The use of dimethyl-sulfoxide (DMSO) in the treatment of interstitial cystitis. Scand J Urol Nephrol1978; 12: 129. Google Scholar 12 : The efficacy of intravesical Tice strain bacillus Calmette-Guerin in the treatment of interstitial cystitis: a double-blind, prospective, placebo controlled trial. J Urol1997; 157: 2090. Link, Google Scholar 13 : The efficacy of intravesical bacillus Calmette-Guerin in the treatment of interstitial cystitis: long-term followup. J Urol1998; 159: 1483. Link, Google Scholar 14 : Bacillus calmette-guérin immunotherapy for refractory interstitial cystitis. Urology1994; 43: 121. Google Scholar 15 : Summary of the National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases Workshop on Interstitial Cystitis, National Institutes of Health, Bethesda, Maryland, August 28–29, 1987. J Urol1988; 140: 203. Link, Google Scholar 16 : Clinical features and spectrum of light microscopic changes in interstitial cystitis. J Urol1990; 143: 1118. Link, Google Scholar 17 : Proliferation and transepithelial migration of mucosal mast cells in interstitial cystitis. Immunology1986; 58: 411. Google Scholar 18 : Recruitment, distribution and phenotypes of mast cells in interstitial cystitis. J Urol2000; 163: 1009. Link, Google Scholar 19 : Intracavitary bacillus Calmette-Guerin in the treatment of superficial bladder tumors. J Urol1976; 116: 180. Link, Google Scholar 20 : Bacillus Calmette-Guerin treatment of existing papillary bladder cancer and carcinoma in situ of the bladder. Four-year results. The Bladder Cancer BCG Study Group. Cancer1995; 75: 552. Google Scholar 21 : Changes in urinary cytokines and soluble intercellular adhesion molecule-1 (ICAM-1) in bladder cancer patients after bacillus Calmette-Guerin (BCG) immunotherapy. Clin Exp Immunol1995; 99: 369. Crossref, Medline, Google Scholar 22 : Systemic immune response after intravesical instillation of bacille Calmette-Guerin (BCG) for superficial bladder cancer. Clin Exp Immunol1999; 115: 131. Google Scholar 23 : Bacillus Calmette-Guerin (BCG) immunotherapy for bladder cancer: review of complications and their treatment. Aust N Z J Surg1998; 68: 340. Crossref, Medline, Google Scholar 24 : Autoantibodies in interstitial cystitis. J Urol1994; 151: 587. Link, Google Scholar 25 : Interstitial cystitis as an autoimmune disease. A review. Eur Urol1980; 6: 10. Crossref, Medline, Google Scholar 26 : Bladder antibodies in interstitial cystitis. J Urol1970; 103: 307. Link, Google Scholar 27 : Interstitial cystitis: bladder mucosa lymphocyte immunophenotyping and peripheral blood flow cytometry analysis. J Urol1990; 144: 868. Link, Google Scholar 28 : Interleukin-6 and interstitial cystitis. J Urol1994; 152: 869. Link, Google Scholar 29 : Selective growth of human mast cells induced by Steel factor, IL-6, and prostaglandin E2 from cord blood mononuclear cells. J Immunol1996; 157: 343. Google Scholar 30 : Metaplastic transformation of urinary bladder epithelium: effect on mast cell recruitment, distribution and phenotype expression. Am J Pathol1998; 153: 149. Google Scholar 31 : Recent advances in the cellular and molecular biology of mast cells. Immunol Today1989; 10: 381. Google Scholar 32 : BCG-induced interleukin-6 upregulation and BCG internalization in well and poorly differentiated human bladder cancer cell lines. Eur Cytokine Netw1998; 9: 181. Google Scholar 33 : DMSO: effect on bladder afferent neurons and nitric oxide release. J Urol1997; 158: 1989. Link, Google Scholar 34 : Self-administration of dimethyl sulfoxide (DMSO) for interstitial cystitis. Urology1986; 28: 10. Google Scholar 35 : Clinical experience with multiagent intravesical therapy in interstitial cystitis patients unresponsive to single-agent therapy. World J Urol1993; 11: 178. Google Scholar From the Department of Urology, Sahlgrenska University Hospital Göteborg, Sweden© 2000 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byClemens J, Erickson D, Varela N and Lai H (2022) Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain SyndromeJournal of Urology, VOL. 208, NO. 1, (34-42), Online publication date: 1-Jul-2022.Hillelsohn J, Rais-Bahrami S, Friedlander J, Okhunov Z, Kashan M, Rosen L and Moldwin R (2012) Fulguration for Hunner Ulcers: Long-Term Clinical OutcomesJournal of Urology, VOL. 188, NO. 6, (2238-2241), Online publication date: 1-Dec-2012.Braunstein R, Shapiro E, Kaye J and Moldwin R (2008) The Role of Cystoscopy in the Diagnosis of Hunner's Ulcer DiseaseJournal of Urology, VOL. 180, NO. 4, (1383-1386), Online publication date: 1-Oct-2008.MAYER R, PROPERT K, PETERS K, PAYNE C, ZHANG Y, BURKS D, CULKIN D, DIOKNO A, HANNO P, LANDIS J, MADIGAN R, MESSING E, NICKEL J, SANT G, WARREN J, WEIN A, KUSEK J, NYBERG L and FOSTER H (2018) A RANDOMIZED CONTROLLED TRIAL OF INTRAVESICAL BACILLUS CALMETTE-GUERIN FOR TREATMENT REFRACTORY INTERSTITIAL CYSTITISJournal of Urology, VOL. 173, NO. 4, (1186-1191), Online publication date: 1-Apr-2005.LOGADOTTIR Y, EHRÉN I, FALL M, WIKLUND N and PEEKER R (2018) Intravesical Nitric Oxide Production Discriminates Between Classic and Nonulcer Interstitial CystitisJournal of Urology, VOL. 171, NO. 3, (1148-1151), Online publication date: 1-Mar-2004. Volume 164Issue 6December 2000Page: 1912-1916 Advertisement Copyright & Permissions© 2000 by American Urological Association, Inc.Keywordsmycobacterium bovispainadministration, intravesicaldimethyl sulfoxidecystitis, interstitialMetricsAuthor Information RALPH PEEKER More articles by this author MOHAMMAD-ALI HAGHSHENO More articles by this author STEN HOLMÄNG More articles by this author MAGNUS FALL More articles by this author Expand All Advertisement PDF downloadLoading ...