The Therapeutic Effect Of Amitriptyline In The Treatment Of Interstitial Cystitis/Bladder Pain Syndrome

PartⅠ The clinical effect of amitriptyline in the treatmentof interstitial cystitis/bladder pain syndromObjective:To evaluate the clinical effect of amitriptyline in the treatment of interstitial cystitis/bladder pain syndrome(IC/BPS).Methods : 103 patients diagnosed in the First Affiliated Hospital of Soochow University from September 2015 to September 2016 were treated with amitriptyline,assisted with patient education,bladder training and mental state adjustment.All IC/BPS patients were evaluated with the questionairs before treatment,4 and 12 weeks after treatment,respectively,incluing the urine dairy,O’Leary-Sant interstitial cystitis symptom(index & problem index),pelvic pain and urgency(PUF),Visual Analogue Scale/Score(VAS),Athens Insomnia Scale(AIS),Self-rating Anxiety Scale(SAS)and Self-rating Depression Scale(SAS).Results:In 103 IC/BPS patients,the incidence rates of anxiety,depression,sleep disorder and sleep disorder suspected were 74.76%,84.47%,22.33% and 48.54%,respectively.After 12 weeks treatment,the incidence rates decreased significantly compared to pre-treatment(42.23% vs.74.76%,54.67% vs.84.47%,3.88% vs.22.33% and 25.24% vs.48.54%).IC/BPS relevant symptoms affecting quality of life were urgency(23.30%),frequency(40.78%),nocturia(10.68%)and pain(25.24%).The 24 h frequency of urination,the functional bladder capacity,ICSI,ICPI,PUF,VAS scores were 24.20±11.15,226.40±44.33,13.78±3.13,8.68±1.73,13.84±3.13,5.27±1.20.After 12 weeks treatment,the indexes above were 13.90±8.71,348.00±84.60,9.50±3.36,6.03±2.78,9.73±3.17,3.78±1.76,respectively.Compared with pre-treatment,the 24 h frequency of urination decreased significantly(P<0.001),the functional bladder capacity increased significantly(P<0.001),the ICSI,ICPS,PUF,VAS scores decreased significantly(P<0.001).The main effects were sedation(10.68%),vertigo(4.85%),constipation(4.85%),and dry mouth(1.94%).Conclusion: The incidence rate of anxiety,and sleep disorder are statistically high.It is the symptom of frequency that troubles the IC/BPS patients most.Amitriptyline can improve the symptoms including anxiety,sleep disorder,frequency,urgency and pain in IC/BPS patients.Amitriptyline is a tolerable,safe and effective treatment for IC/BPS.Part Ⅱ The clinical efficacy of amitriptyline combined with intravesical instillationObjective: To investigate the clinical effect of amitriptyline combined with intravesical instillation of drugs.Methods: 63 patients diagnosed with IC/BPS in the First Affiliated Hospital of Soochow University from December 2015 to November 2016 and received amitriptyline for 3 months ineffectively were enrolled.Intravesical instillation of drugs was performed on the basis of amitriptyline treatment.The patients were treated with intravesical instillation of drugs,assisted with patient education and bladder training.All IC/BPS patients were evaluated with the questionnaires before treatment,4 and 12 weeks after treatment,respectively,including the urine dairy,O’Leary-Sant interstitial cystitis symptom(index & problem index),and pelvic pain and urgency(PUF).Results: A total of 63 IC/BPS patients were enrolled in the study.The age range from 26 to 73 years old,with an average age of(51.4±13.6)years old.Before treatment,the 24 h frequency of urination,the bladder functional capacity,ICSI,ICPI,PUF were 24.20±11.15、226.40±44.33、11.09±2.18、11.32±2.82、13.76±3.124,respectively;4 weeks after treatment,they were 14.81±7.45、32.20±60.04、8.52±2.92、8.65±2.04、10.12±3.33 respectively.12 weeks after treatment,13.77±8.71、342.56±84.10、7.57±2.41、6.89±1.82、10.25±3.42,respectively.The 24 h frequency of urination was significantly reduced,and the bladder functional capacity increased significantly,the ICSI,ICPI,PUF scores increased significantly(P < 0.001).Conclusion: Amitriptyline combined with intravesical instillation improves the effect on the IC/BPS patients,and is a safe and effective treatment.