OBJECTIVE: To investigate the efficacy of using alkalinized lidocaine combined with heparin bladder perfusion in the treatment of the clinically difficult female interstitial cystitis/chronic pelvic pain syndrome (IC/CPPS).
Clinical data: From October 2004 to March 2006, 245 female patients with interstitial cystitis/chronic pelvic pain syndrome (IC/CPPS), aged 28-69 years, mean 45.3±18.9 years, were treated in our hospital as outpatients, all complaining of lower abdominal acidity/pain and frequent nocturnal urination with/without urinary frequency and urgency. All patients underwent 24-hour voiding card recording, urinary routine, ultrasound and cystoscopy to exclude urinary tract infections, stones, bladder tumors (including carcinoma in situ), chemical cystitis, adenocystitis, tuberculous cystitis and gastroenterology/gynecology-related diseases; all patients had a disease duration of >9 months; oral anticholinergic drugs were ineffective; 31 patients had a bladder capacity of <350 ml and 214 patients had a bladder capacity of >350 ml. All patients were given O’Leary-Sant IC questionnaire scores before and after treatment. Lu Jianwei, Department of Urology, Shanghai Renji Hospital
Treatment: We used alkalinized lidocaine combined with heparin bladder irrigation to treat the patient in an outpatient lithotomy position, strictly disinfected the perineum and around the urethral orifice to prevent secondary infection, placed an 8-gauge silicone catheter, slowly injected a mixture of 2% lidocaine 20 ml + heparin 37,500 units + 5% sodium bicarbonate 5 ml into the bladder, and instructed the patient to keep it for 1-2 hours after Urination, 1-2 times a week by instillation for 8 weeks.
Results: 215 patients were completely followed up for 1-18 months, with a mean of 8.7 months. According to the comparison of data from the O’Leary-Sant IC questionnaire, the improvement rates were 71.2% for lower abdominal soreness/pain, 65.3% for nocturia, and a relatively insignificant 21.5% for urinary frequency and urgency; the overall post-treatment satisfaction rate was 74.8%. There were no significant adverse effects in the treatment, and 9 people complained of dizziness and drowsiness after bladder perfusion, and the symptoms disappeared after administration of a reduced dose. Among the patients with effective treatment, 21 patients had recurrence of symptoms after about six months and were given reperfusion treatment.
Discussion: The diagnosis of interstitial cystitis (IC) is complex, and the NIDDK developed a series of diagnostic exclusion criteria in 1987, but in recent years, more and more scholars believe that this diagnostic criteria may miss a large number (60%) of patients with IC, so in recent years, until the latest diagnostic criteria for IC are developed, those patients with suspected IC are collectively referred to as interstitial cystitis/chronic pelvic pain syndrome (IC/CP) internationally. pain syndrome (IC/CPPS) or painful bladder syndrome (PBS).
In this study, we concluded that in patients with suspected IC symptoms, when all methods of treatment are ineffective, alkaline lidocaine combined with heparin bladder perfusion can be considered, which is safe without significant adverse effects, avoids the side effects of oral drugs on the gastrointestinal tract, and is inexpensive. Based on the data of this study we believe that this method is most effective especially for symptoms of lower abdominal soreness/pain and frequent nocturia.