Therapeutic efficacy of multimodal therapy for patients with interstitial cystitis/bladder pain syndrome refractory to previous bladder monotherapy.

[PURPOSE] Interstitial cystitis/painful bladder syndrome (IC/BPS) is a debilitating chronic condition, and current treatments rarely achieve complete symptom relief. This study evaluated the efficacy of intensive multimodal therapy (MMT) for IC/BPS based on individualized clinical assessments within a 3-month period.

[METHODS] Thirty-one patients with IC/BPS who had failed prior monotherapy were enrolled. Following comprehensive evaluation, patients received tailored MMT, which could include anti-inflammatory medications, intravesical hyaluronic acid instillation, intravesical or urethral botulinum toxin A (BoNT-A) injection, pelvic floor BoNT-A injection, platelet-rich plasma injection, low-energy shockwave therapy, pelvic floor massage for pelvic floor muscle pain (PFMP), and/or medications for anxiety, depression, voiding dysfunction, or bladder hypersensitivity. The primary outcome was assessed at 3 months using the global response assessment (GRA), with a successful response defined as a GRA score of 2 or 3. Patients were followed for up to 1 year.

[RESULTS] Of the 31 patients (28 women, 3 men), 18 (58.1%) reported a successful outcome at 3 months. Successful and unsuccessful subgroups showed significant improvements in symptom scores and glomerulation grade after cystoscopic hydrodistention. However, reductions in pain VAS and daytime frequency were observed only in the successful subgroup. Similarly, PFMP parameters improved significantly in the successful subgroup, but not in the failed subgroup. Sustained therapeutic effects were observed in 21 patients (67.7%) at 9 months and in 23 patients (74.2%) at 1 year after MMT.

[CONCLUSION] Multimodal bladder therapy, incorporating bladder- and extra-bladder-targeted approaches, yields satisfactory outcomes in patients with IC/BPS unresponsive to prior monotherapy.