Revealing distinct treatment mechanisms and outcome correlations in patients with interstitial cystitis/bladder pain syndrome after different bladder therapies through urinary biomarker analysis.

[PURPOSE] Urinary cytokine changes may serve as biomarkers to assess treatment outcomes for interstitial cystitis/bladder pain syndrome (IC/BPS). This study analyzed the changes in urinary cytokines following various bladder therapies and explored their clinical significance in therapeutic mechanisms.

[METHODS] A total of 122 patients with IC/BPS treated with platelet-rich plasma (PRP), botulinum toxin-A (BoTN-A), hyaluronic acid (HA), or low-energy shock wave (LESW) were evaluated. Urinary inflammatory and oxidative stress biomarkers were measured at baseline and at 3 months posttreatment. Treatment outcomes were assessed using the Global Response Assessment (GRA), a 10-point visual analog score for pain, and the O'Leary-Saint Symptom Score (OSS). A GRA ≥ 2 was considered indicative of effective treatment.

[RESULTS] Significant symptom improvement was observed in patients treated with PRP and BoNT-A but not with LESW or HA. At 3 months post-treatment, PRP therapy led to decreased urinary 8-isoprostane and total antioxidant capacity levels, while BoNT-A therapy reduced monocyte chemotactic protein-1 and 8-hydroxy-2'-deoxyguanosine levels. HA therapy did not alter urinary biomarker levels, whereas LESW therapy increased macrophage inflammatory protein-1 beta and tumor necrosis factor-α levels. Patients with significant urinary biomarker reductions (GRA ≥ 2) demonstrated clinical improvement at 3 months.

[CONCLUSION] PRP or BoNT-A exhibits anti-inflammatory effects, reflected by reductions in urinary cytokine levels, correlating with positive treatment outcomes. Urinary cytokine changes may play a role to evaluate the mechanisms of action of various treatments in patients with IC/BPS.