Abstract
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 síndrome da bexiga dolorosa (SBD), é uma doença
crônica e debilitante que afeta principalmente mulheres. É caracterizada por dor pélvica
associada à urgência miccional, frequência urinária, noctúria 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 também pode estar associada
a sintomas moderados e menos debilitantes. Embora existam vários ensaios clínicos
para avaliar terapias orais e intravesicais, o tratamento para IC permanece longe
do ideal. Esta revisão sistemática avaliou ensaios clínicos randomizados publicados
sobre medicamentos orais usados para tratar sintomas de SBD. Este estudo foi realizado
de acordo com o método preferred reporting items for systematic reviews and meta-analyses (PRISMA). Dois revisores independentes examinaram os estudos para determinar sua
inclusão ou exclusão e para realizar a análise metodológica. Os critérios de inclusão
foram: ensaios clínicos randomizados publicados entre abril de 1988 e abril de 2016
que usaram medicações orais no tratamento dos sintomas da SBD ou CI. De acordo com
a revisão sistemática realizada, a melhor opção de medicação oral para o tratamento
dos SBD é o pentosano polissulfato sódico. No entanto, esta droga não está disponível
no Brasil. A amitriptilina administrada por via oral é um tratamento eficaz para SBD
e deve ser oferecida como primeira escolha.
Keywords
bladder pain syndrome - interstitial cystitis - oral therapy
Descritores
síndrome da bexiga dolorosa - cistite intersticial - terapia oral
