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Comparative Study
. 2019 Aug;30(8):1293-1301.
doi: 10.1007/s00192-019-03892-2. Epub 2019 Mar 14.

Prospective comparative study of the effects of lidocaine on urodynamic and sensory parameters in bladder pain syndrome

Ifeoma Offiah  1   2   3 , Elaine Dilloughery  4 , Stephen B McMahon  5 , Barry A O'Reilly  4   6   7
Affiliations
Comparative Study

Prospective comparative study of the effects of lidocaine on urodynamic and sensory parameters in bladder pain syndrome

Ifeoma Offiah et al. Int Urogynecol J. 2019 Aug.

Abstract

Introduction and hypothesis: Intravesically administered lidocaine is used in patients with bladder pain syndrome (BPS) to test the hypothesis that symptoms have a peripheral versus central mechanism.

Methods: A cross-sectional study of 24 female patients with BPS was performed. The Central Sensitisation Inventory (CSI) and Kings Health Questionnaire (KHQ) were completed. Urodynamic assessment was undertaken. Women were asked to report their pain using a numeric rating scale at cystometric capacity and post void. Participants then received an intravesical instillation of either 20 ml of 2% alkalinised lidocaine (n = 16) or 20 ml of normal saline (n = 8). These solutions were allowed to remain in situ for 20 min and pain score repeated. Urodynamics was repeated.

Results: There was a statistically significant volume increase following lidocaine treatment: maximal cystometric capacity (MCC) 192-261 ml post lidocaine (p = 0.005.) In contrast, there was no significant difference in the saline controls: MCC 190-183 ml (p = 0.879.) Individual analysis revealed five of 16 lidocaine participants did not respond to lidocaine. These five reported a significantly worse quality of life (QoL) than lidocaine responders and had a tendency towards central sensitivity syndromes.

Conclusion: Lidocaine significantly improved MCC in 11/16 participants in this study. These patients appear to have peripherally mediated disease. However, the failure of response to treatment in five participants, as well as their tendency towards central sensitivity syndromes, implies that in this subgroup, a peripheral drive from the bladder is not critical to their pain, suggesting central nervous system (CNS) pathology. This simple and safe test could be used to stratify patients for research or therapeutic trials.

Keywords: Bladder pain syndrome; Central sensitisation; Lidocaine; Peripheral pain modulation; Urodynamics.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Mean numeric pain score at cystometric capacity, post void and post lidocaine or saline treatment ±1 standard error of the mean (SEM), calculated using the Mann–Whitney U Test. There is a significant decrease in pain score following lidocaine treatment (n = 16), which was not apparent post saline treatment (n = 8). Statistical analysis performed using the Mann–Whitney U test, with a U value of 72 (p = 0.0183) post lidocaine and U value of 30 (p = 0.356) post saline
Fig. 2
Fig. 2
Mean volume for each sensation felt ± 1 standard error of the mean (SEM) for the first urodynamic examination and for the lidocaine and saline treatment urodynamics. Significance for each sensation volume was calculated using paired Student’s t test pre- and post treatment, and for the difference between urodynamic examinations using two-way analysis of variance (ANOVA). UDS urodynamic, MCC maximal cyctometric capacity, CC cystometric capacity
Fig. 3
Fig. 3
Mean numeric pain scores for each group following either lidocaine or saline treatment. The lidocaine treatment group are divided into responders and non-responders. Significance calculated using two-way analysis of variance (ANOVA) with Bonferroni multiple test comparison. ** p < 0.01, ***p < 0.001, ns non-significant.
Fig. 4
Fig. 4
a Mean bladder capacity as perceived by participants in pre- and post treatment ±1 standard error of the mean (SEM). b First urodynamic results (blue) and subsequent distension volumes following treatment. Significance calculated using two-way analysis of variance (ANOVA) with Bonferroni multiple test comparison. MCC maximum cystometric capacity. *p < 0.05, ***p < 0.001
Fig. 5
Fig. 5
Lidocaine responders (red) versus non-responders (grey) and the presence or absence of concomitant central sensitisation syndromes (CSS) (disease). Non-responders are significantly more likely to have concomitant CSS than responders. Odds ratio (OR) = 5.423, 95% confidence interval (CI) = 2.517–11.68, p = < 0.0001
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