GnRH agonists may offer novel option for interstitial cystitis. (Cyclic Irritable Bladder Symptoms).
Eight of nine patients prescribed GnRH agonists for 6 months "markedly improved," even though they had failed numerous other therapies for long-standing pain associated with interstitial cystitis, said Dr. Gretchen Lentz of the university in Seattle.
Two patients relapsed once the trial was completed, hut both were cured when one underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy and the other, a bilateral salpingo-oophorectomy Dr. Lentz reported at the annual meeting of the Pacific Coast Obstetrical and Gynecological Society.
The sole patient who failed the trial of GnRH agonists also failed to improve after a total abdominal hysterectomy and bilateral salpingo-oophorectomy the investigator said.
In another arm of the study OCs were prescribed to six patients who similarly suffered chronic, cyclic interstitial cystitis symptoms, and five improved.
Dr. Lentz called the results "interesting," and said hormone manipulation for interstitial cystitis "certainly merits more study" especially in light of published studies documenting sustained improvement of irritable bowel syndrome symptoms in patients given GnRH agonists.
The 15 patients who received treatment were among 23 included in a multidisciplinary evaluation of women with chronic irritable bladder symptoms who reported cyclic variations in their pain, Dr. Lentz said.
Among the larger group of 23, the average age of patients was 36, and they had a mean duration of symptoms of 9.5 years.
Premenstrual exacerbation of symptoms was noted by 18; three reported that their symptoms were worse or better with menstruation.
The majority (19 of 23) had classic suprapubic pain normally associated with interstitial cystitis, but, as is evident in other studies, pain was also reported in the urethra, vagina, and/or low back.
"I want to impress upon you that these patients had pretty intractable pain, and had really exhausted most of the other therapies that have been tried for interstitial cystitis," she said.
Fifteen patients opted to undergo a diagnostic laparoscopy which revealed endometriosis in 10, according to Dr. Lentz.
"I found that quite shocking, given the fact that these patients had had pain an average of 9.5 years, and all had seen gynecologists," she said.
She speculated that gynecologists may have focused more on patients' symptoms of pressure, frequent nocturia, and suprapubic pain than on the cyclic nature of their symptoms.
One patient was determined to have chronic pelvic inflammatory disease with adhesions. No unusual findings were found in another.
Dr. Lentz noted that even patients who were not found to have endometriosis improved when prescribed GnRH agonists or oral contraceptives.
She has continued to see all but two of the original patients in the study with an average follow-up now of 55 months.
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|Publication:||OB GYN News|
|Date:||Dec 1, 2001|
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