Bladder pain syndrome/interstitial cystitis: present and future treatment perspectives.

Bladder pain syndrome/Interstitial cystitis (BPS/IC) is a debilitating chronic disease of unknown etiology. Treatment is not well defined and is still under intense investigation. The aim of this paper was to review existing literature on treatment of BPS/IC and examine current evidence on present and future perspective. PubMed database was researched and publications in English language on the topic were analyzed, emphasis was given to publications that occurred on the last five years. Mainstays of oral therapies are still empirical due to lack of knowledge on etiology of this disease. The few oral drugs that showed efficacy in placebo controlled trials are amytriptiline, pentosan polysulfate sodium, hydroxyzine and cyclosporine A. As for intravesical treatments reasonable evidence is available only for dimethyl sulfoxide and resection of visible Hunner's lesions. Reconstructive surgery can also be recommended in selected cases. Further studies into the causes and mechanisms of the disease are paramount for the development of effective treatments. Foreseeable therapeutic objectives will comprehend oral blockade of sensory nerve receptors, immune system modulation, peripheral nerve fiber inactivation/desensitization, anti-proliferative factor blockade and pain gene therapy. Identification of BPS/IC phenotypical subgroups should help delineate proper individualized treatment which will be aimed at the disease and its multiple manifestations rather than at focalized complaints. Present treatment of BPS/IC comprises pain control in conjunction with control of supposed underlying bladder disease. Based on identified possible therapeutic targets several treatment possibilities warrant further investigation. Identification of BPS/IC phenotype is a important step for correct management.