Systematic Review of Oral Therapy for the Treatment of Symptoms of Bladder Pain Syndrome: The Brazilian Guidelines
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2018
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Castro, Rodrigo de Aquino 
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Interstitial cystitis (IC), including bladder pain syndrome (BPS), is a chronic and debilitating disease that mainly affects women. It is characterized by pelvic pain associated with urinary urgency, frequency, nocturia and negative urine culture, with normal cytology. In 2009, the Society for Urodynamics and Female Urology (SUFU) defined the term IC/BPS as an unpleasant sensation (pain, pressure, and discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms for more than 6 weeks duration, in the absence of infection or other identifiable causes. This is the definition used by the American Urological Association (AUA) in the most recent guidelines on IC/BPS. Interstitial cystitis may be sufficiently severe to have a devastating effect on the quality of life, but it may also be associated with moderate symptoms whose effects are less debilitating. Although there are several clinical trials to assess oral and intravesical therapies, the treatment for IC remains far from ideal. This systematic assessment evaluates published randomized clinical trials on oral medications used to treat symptoms of BPS. This study was performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) method. Two independent reviewers screened the studies to determine their inclusion or exclusion and to perform the methodological analysis. The inclusion criteria included randomized studies published between April of 1988 and April of 2016 that used oral medications to treat symptoms of BPS or IC. According to the systematic review performed, we should consider pentosan polysulfate as one of the best options of oral drugs for the treatment of BPS symptoms. However, this drug is not an available option in Brazil. Orally administered amitriptyline is an efficacious medical treatment for BPS, and it should be the first treatment offered. Resumo Cistite intersticial (IC), incluindo a sindrome da bexiga dolorosa (SBD), e uma doenca cronica e debilitante que afeta principalmente mulheres. E caracterizada por dor pelvica associada a urgencia miccional, frequencia urinaria, nocturia e exame cultural de urina negativo, com citologia normal. A cistite intersticial pode ser suficientemente severa para ter um efeito devastador na qualidade de vida, mas tambem pode estar associada a sintomas moderados e menos debilitantes. Embora existam varios ensaios clinicos para avaliar terapias orais e intravesicais, o tratamento para IC permanece longe do ideal. Esta revisAo sistematica avaliou ensaios clinicos randomizados publicados sobre medicamentos orais usados para tratar sintomas de SBD. Este estudo foi realizado de acordo com o metodo preferred reporting items for systematic reviews and meta-analyses (PRISMA). Dois revisores independentes examinaram os estudos para determinar sua inclusAo ou exclusAo e para realizar a analise metodologica. Os criterios de inclusAo foram: ensaios clinicos randomizados publicados entre abril de 1988 e abril de 2016 que usaram medicacoes orais no tratamento dos sintomas da SBD ou CI. De acordo com a revisAo sistematica realizada, a melhor opcAo de medicacAo oral para o tratamento dos SBD e o pentosano polissulfato sodico. No entanto, esta droga nAo esta disponivel no Brasil. A amitriptilina administrada por via oral e um tratamento eficaz para SBD e deve ser oferecida como primeira escolha.
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Revista Brasileira De Ginecologia E Obstetricia. Rio De Janeiro Rj, v. 40, n. 2, p. 96-102, 2018.