Bladder Instillation Patterns in a Cohort of Women With Interstitial Cystitis/Bladder Pain Syndrome

Importance Interstitial cystitis/bladder pain syndrome (IC/BPS) is a prevalent disorder known to be notoriously difficult to treat.Objective The aim of the study was to determine intravesical instillation patterns among women receiving treatment for IC/BPS.Study Design This was a retrospective claims-based analysis using the Veterans Affairs Informatics and Computing Infrastructure. Females with an International Classification of Diseases, Ninth Revision, diagnosis of IC/BPS (595.1) were sampled randomly. Patients were considered to have IC/BPS if they had 2 visits with bladder pain in the absence of a positive urine culture 6 weeks or more apart or a history of bladder pain with another visit for bladder pain. Dates of intravesical instillations were extracted. A "course" of instillations was defined as 1 or more instillations made with less than 21 days between visits.Results We identified 641 women with a confirmed diagnosis of IC/BPS, 78 of whom underwent a total of 344 intravesical instillations. On average, each woman had 1.5 +/- 0.8 courses between October 2004 and July 2016. Each course was an average of 3.1 +/- 2.6 instillations. Fifty-five percent of courses consisted of 1 instillation. Only 22% of courses had 6 or more instillations, the number typically recommended to achieve clinical response. Each instillation within a course was an average of 9.4 +/- 4.0 days apart. Most instillations (77%) involved a cocktail of 2 or more drugs.Conclusions In our cohort, few women with IC/BPS received a recommended treatment course of 6 weekly instillations, with most receiving only 1 per course. Future studies are needed to determine whether instillation courses were altered from the guidelines due to health care provider practice patterns, early improvement, or poor tolerance of instillations.