Endoscopic Injection of Low Dose Triamcinolone: A Simple, Minimally Invasive, and Effective Therapy for Interstitial Cystitis With Hunner Lesions

Urology. 2018 Aug:118:25-29. doi: 10.1016/j.urology.2018.03.037. Epub 2018 May 18.

Abstract

Objective: To investigate the efficacy of low dose triamcinolone injection for effectiveness and durability in patients with interstitial cystitis/bladder pain syndrome (IC/BPS) with Hunner lesions (HL).

Materials and methods: Clinical data from patients with HL who underwent endoscopic submucosal injection of triamcinolone were reviewed. Demographics, pre- and postoperative pain and nocturia scores, and long-term clinical outcomes were assessed. Duration of response was estimated by time to repeat procedure. Kaplan-Meier estimator was used to evaluate time to repeat procedure.

Results: A total of 36 patients who received injections of triamcinolone between 2011 and 2015 were included. Median age ± standard deviation of patients was 61.5 ± 12.0 years; 28 (77.8%) were female patients and 8 (22.2%) were male patients. Twenty six patients (72.2%) received only 1 set of injections, 8 (22.2%) received 2 sets of injections, and 2 (5.56%) received 3 or more sets of injections. Average time between injections in those receiving more than 1 set of injections was 344.9 days (median: 313.5, range: 77-714). Preprocedural pain scores were 8.3 ± 1.2 (mean ± standard deviation) on Likert pain scale (0-10), and mean postprocedural pain scores at approximately 1 month were 3.8 ± 2.2, P <.001. Mean preprocedural nocturia bother scores was 7.5 ± 2.0 and mean postprocedural nocturia bother scores was 5.1 ± 2.5, P <.001.

Conclusion: Endoscopic submucosal injection of low dose triamcinolone in patients with IC/BPS with HL is an effective and durable adjunct to existing treatment modalities. This approach is associated with low morbidity and can be performed on an outpatient basis.

MeSH terms

  • Administration, Intravesical
  • Administration, Mucosal
  • Aged
  • Cystitis, Interstitial* / diagnosis
  • Cystitis, Interstitial* / drug therapy
  • Cystitis, Interstitial* / physiopathology
  • Dose-Response Relationship, Drug
  • Female
  • Glucocorticoids / administration & dosage
  • Humans
  • Injections
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Pain Management
  • Pain Measurement
  • Pain* / diagnosis
  • Pain* / drug therapy
  • Pain* / etiology
  • Retreatment* / methods
  • Retreatment* / statistics & numerical data
  • Retrospective Studies
  • Treatment Outcome
  • Triamcinolone / administration & dosage*
  • United States

Substances

  • Glucocorticoids
  • Triamcinolone