CLINICAL MONITORING OF REFRACTORY INTERSTITIAL CYSTITIS DURING PHARMACOTHERAPY IN WOMEN

Abstract

Refractory interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic condition marked by resistance to standard treatments and persistent symptoms such as pelvic pain, urgency, frequency, and reduced bladder capacity. Objective – to improve treatment outcomes in women with refractory IC/BPS by using a personalized multimodal approach combining intravesical botulinum toxin type A (BTA), gabapentin, and hydroxychloroquine. Materials and methods. A prospective study included 67 women diagnosed with refractory IC/BPS. Patients were assigned to two groups: the control group (n=32) received intravesical BTA alone, while the main group (n=35) received the combination therapy. Treatment lasted 6 months, with follow-up for 12 months. Efficacy was evaluated using O’Leary-Sant questionnaires, VAS for pain, urinary diaries, and cystoscopy. Results. Combination therapy showed superior efficacy over BTA monotherapy. In 6 months, 80% of patients in the main group reported good/satisfactory outcomes vs. 53.1% in the control group. At 12 months, Hunner’s ulcers were observed in 22.85% of the main group vs. 59.37% of the control group (p < 0.001); glomerulations occurred in 40% vs. 87.5% (p < 0.001). Functional bladder capacity improved by 99.05%. Pain (VAS) decreased by 68.3%, urinary frequency by 54.6%, urgency by 76.1%, nocturia by 69.7%, and ICSI/ICPI scores by 70% and 65.9%, respectively (p < 0.05). Conclusion. The combination therapy offers better symptom control, improved urothelial healing, and sustained results compared to BTA monotherapy