Stepwise Treatment Strategy for Interstitial Cystitis/Bladder Pain Syndrome: Insights from Real-World Clinical Practice

Objective: To assess the real-world efficacy of a guideline-based stepwise treatment approach in patients with interstitial cystitis/bladder pain syndrome who do not respond to lifestyle modifications. Material and Methods: This retrospective study included 75 female patients with a confirmed diagnosis of interstitial cystitis/bladder pain syndrome, each with a minimum follow-up period of 12 months. None of the participants responded to initial conservative treatment or subsequently underwent a sequential therapeutic regimen. This regimen was initiated with oral pentosan polysulfate sodium, followed by intravesical sodium chondroitin sulfate and Onabotulinum toxin a injections. Treatment efficacy was assessed on the basis of the patient’s global impression of the change scale. Results: Long-term symptom management with oral pentosan polysulfate sodium was successfully achieved in 38.7% of patients. Among those who transitioned to intravesical sodium chondroitin sulfate, 63.1% reported experiencing “much” or “very much” improvement according to the patient global Impression of change scale. Onabotulinum toxin A significantly improved in 58.8% of the patients. The overall response rate across all treatment levels was 89.3%. Adverse effects are infrequent and generally mild. Conclusion: A stepwise treatment protocol tailored to individual patient responses has been demonstrated to be both effective and well tolerated in the management of interstitial cystitis/bladder pain syndrome. These findings advocate the incorporation of flexible, patient-centered therapeutic strategies in clinical practice and underscore the need for prospective studies employing validated outcome measures. Keywords: botulinum toxins, chondroitin sulfates, interstitial cystitis, urinary bladder diseases