Decreasing symptoms in interstitial cystitis patients: pentosan polysulfate vs. sacral neuromodulation

Abstract

Oral pentosan polysulfate (PPS) is the only FDA-approved drug for interstitial cystitis (IC). Several studies have been conducted that show PPS will reduce IC symptoms. Sacral neuromodulation is a newer therapy for IC that has been FDA-approved in incontinent patients. Studies conducted in IC patients have shown that sacral neuromodulation reduces IC symptoms. Both therapies have documents reduction in IC symptoms, but no studies have compared these therapies to see which is more effective.

Methods: An evidence-based systematic literature review was conducted using Pubmed, Medline, and Proquest nursing journals. Inclusion criteria for the studies were a peer-reviewed article, publish date of 1990 or later, level 1 or 2 evidence, were diagnosed with IC, and were only treated with either oral PPS or sacral neuromodulation during the study. Patients were excluded if they were on multiple therapies for IC or a non-IC diagnosis.

Results: Three PPS studies fit all inclusion criteria. With successful treatment being defined as a 50% overall improvement in symptoms, studies had a success rate of 26-32%. Four studies fit the criteria for sacral neuormodulation. In these studies 40-94% of the patients had a 50% improvement in one or more of the presenting symptoms of IC.

Conclusions: PPS and sacral neuromodulation have both been shown to reduce IC symptoms. Sacral neuromodualtion has been shown to have a higher rate of symptom relief in IC patients. Based on level 2 evidence, a Grade B recommendation can be made for sacral neuromodulation. This evidence as limited by sacral neuromodulation studies having only a level 2 evidence, while PPS has level 1 evidence studies. More studies are needed for each of these therapies.