Which bladder instillations are more effective? DMSO
vs. bupivacaine/heparin/triamcinolone: a retrospective study
Received: 16 August 2016 / Accepted: 3 January 2017 / Published online: 1 February 2017
The International Urogynecological Association 2017
Introduction and hypothesis Bladder pain syndrome/
interstitial cystitis (BPS/IC) is a chronic and debilitating con-
dition. Our objective was to compare two different bladder
instillation treatments in patients with BPS/IC: dimethyl sulf-
oxide with triamcinolone (DMSO) vs. bupivacaine with hep-
arin and triamcinolone (B/H/T). Our hypothesis was that both
treatments are equally effective.
Methods A retrospective cohort study of instillation-naïve pa-
tients was conducted comparing responses to either DMSO or
B/H/T at our tertiary urogynecology center from 2012 to 2014.
The primary outcome was patient-reported percent of overall
improvement from baseline. Secondary outcomes were
change in patient-reported daytime voiding frequency
(hours) and change in number of nighttime voiding episodes.
Variables analyzed as potential confounders included pelvic
pain, cystoscopy findings, levator spasm, and fibromyalgia.
The two-sided Student’s t test, chi-squared test, Poisson re-
gression, and repeated-measure analysis of variance
(ANOVA) were used for analyses.
Results One hundred and ninety-three eligible patients were
identified (45 receiving DMSO, 146 receiving B/H/T).
Compared with baseline, DMSO patients reported 63% im-
provement (p < 0.0001), increased time between daytime
voids by 1.5 h (p < 0.00), and a 40% reduction in nocturia
episodes (p < 0.00). B/H/T patients reported 51% improve-
ment (p < 0.00), increased time between daytime voids by
1.4 h (p < 0.00), and an 8% reduction in nocturia episodes
(p = 0.26). When comparing the two treatments, DMSO re-
sulted in a greater percentage of overall improvement
(p = 0.02) and a significant decrease in nocturia episodes
when compared with B/H/T (p = 0.02). There was no signifi-
cant difference between treatments for daytime voiding fre-
quency (p =0.50).
Conclusion Bladder instillations with DMSO or B/H/T pro-
vide overall symptomatic improvement and improved fre-
quency and nocturia. DMSO appears to provide greater im-
provement in nocturia and overall.
Keywords Interstitial cystitis
Bladder pain syndrome/interstitial cystitis (BPS/IC) is a debil-
itating chronic condition characterized by common clinical
symptoms of urinary urgency, pain with urinary voiding,
nocturia, and urinary frequency . BPS/IC more commonly
occurs in women and is often diagnosed after referral to a
urogynecologist or urologist. These symptoms often disrupt
sleep, work, and the social life patients.
Treatment options are targeted toward pain control and
improving symptoms. The American Urological Society
(AUA) recommends conservative treatment, such as patient
education, attention to dietary triggers, and stress manage-
ment, as first-line therapies . Second-line treatments
These data were presented at the Society for Urodynamics and Female
Pelvic Medicine and Reconstructive Surgery Winter meeting as a
moderated poster presentation, New Orleans, LA, USA, Feb 2016.
These data were also presented as an oral poster presentation at the
annual meeting for the International Urogynecological Association
meeting scheduled for cape Town, South Africa, August 2016.
* Shilpa Iyer
Department of Obstetrics and Gynecology, Division of
Urogynecology, North Shore University Health System, 9650 Gross
Point Road., Suite 3900, Skokie, IL 60076, USA
Int Urogynecol J (2017) 28:1335–1340