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Meta-Analysis
. 2024 Apr 24;24(1):95.
doi: 10.1186/s12894-024-01485-w.

Current updates relating to treatment for interstitial cystitis/bladder pain syndrome: systematic review and network meta-analysis

Jae Joon Park #  1 , Kwang Taek Kim #  2 , Eun Ji Lee  3 , Joey Chun  1   4 , Serin Lee  1   5 , Sung Ryul Shim  6   7 , Jae Heon Kim  8
Affiliations
Meta-Analysis

Current updates relating to treatment for interstitial cystitis/bladder pain syndrome: systematic review and network meta-analysis

Jae Joon Park et al. BMC Urol. .

Abstract

Background: Despite the publication of several meta-analyses regarding the efficacy of certain therapies in helping individuals with interstitial cystitis (IC) / bladder pain syndrome (BPS), these have not provided a comprehensive review of therapeutic strategies. The study aimed to determine the efficacy of various therapies for IC/BPS and identify potential moderating factors using randomized controlled trials (RCTs).

Methods: We queried the PubMed, Cochrane, and Embase databases to identify prospective RCTs using inclusion criteria: 1) patients diagnosed with IC, 2) interventions included relevant treatments, 3) comparisons were a specified control or placebo, 4) outcomes were mean differences for individual symptoms and structured questionnaires. The pairwise meta-analysis and network meta-analysis (NMA) were performed to compare the treatments used in IC/BPS. Hedges' g standardized mean differences (SMDs) were used for improvement in all outcomes using random-effects models. Efficacy outcomes included individual symptoms such as pain, frequency, urgency, and nocturia, as well as structured questionnaires measuring IC/BPS symptoms.

Results: A comprehensive literature search was conducted which identified 70 RCTs with 3,651 patients. The analysis revealed that certain treatments, such as instillation and intravesical injection, showed statistically significant improvements in pain and urgency compared to control or placebo groups in traditional pairwise meta-analysis. However, no specific treatment demonstrated significant improvement in all outcomes measured in the NMA. The results of moderator analyses to explore influential variables indicated that increasing age was associated with increased nocturia, while longer follow-up periods were associated with decreased frequency.

Conclusion: This systematic review and meta-analysis provide insights into the efficacy of various treatments for IC. Current research suggests that a combination of therapies may have a positive clinical outcome for patients with IC, despite the fact that treatment for this condition is not straightforward.

Trial registration: PROSPERO CRD42022384024.

Keywords: Administration; Cystitis; Interstitial; Intravesical; Lower Urinary Tract Symptoms; Medication Therapy Management; Overactive; Pain; Physical Therapy Modalities; Urinary Bladder.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flowchart
Fig. 2
Fig. 2
Forest plots for individual symptoms of pain, frequency, urgency, and nocturia (clockwise) in pairwise meta-analysis. SMD, standardized mean difference; CI, confidence interval; PPS, pentosane polysulfate; MPD, monophosphate dehydrogenase; HA, hyaluronic acid; CS, chondroitin sulfate; HL, heparin sodium-lidocaine; BTX, botulinum toxin
Fig. 3
Fig. 3
Forest plots for structured questionnaires of ICPI, ICSI, PUF, and FBV (clockwise) in pairwise meta-analysis. SMD, standardized mean difference; CI, confidence interval; PPS, pentosane polysulfate; MPD, monophosphate dehydrogenase; HA, hyaluronic acid; CS, chondroitin sulfate; HL, heparin sodium-lidocaine; BTX, botulinum toxin; ICPI, interstitial cystitis problem index; ICSI, interstitial cystitis symptom index; PUF, pelvic pain – urgency - frequency symptom scale; FBV, functional bladder volume
Fig. 4
Fig. 4
Network plots, forest plots, and SUCRA values of pain in network meta-analysis
See this image and copyright information in PMC

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