S&T-23 INTRAVESICAL TACROLIMUS IN TREATMENT OF BLADDER PAIN SYNDROME/INTERSTITIAL CYSTITIS

You have accessJournal of UrologyScience & Technology Posters1 Apr 2016S&T-23 INTRAVESICAL TACROLIMUS IN TREATMENT OF BLADDER PAIN SYNDROME/INTERSTITIAL CYSTITIS Nagendra Nath Mishra Nagendra Nath MishraNagendra Nath Mishra More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2852AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bladder Pain Syndrome/Interstitial cystitis (BPS/IC) is a chronic disease with no cure. Immunosuppressant like cyclosporine have been tried with success but limiting factor is side effect. Tacrolimus is similar to cyclosporine in action and also effective in disease like rheumatoid arthritis and atopic dermatitis which are similar to BPS/ IC. In this pilot study Tacrolimus has been used intravesically in patients of severe IC for the first time in the world. The hypothesis is Tacrolimus in the dose of 0.08 – 0.1 mg per kg of body weight will be able to control the symptoms of IC and the side effect profile will be negligible when instilled intravesically. Mycophenolate Mofetil has also been tried in IC but the trial was stopped by USFDA on concerns about safety in pregnancy. Tacrolimus is safe in pregnancy METHODS Tacrolimus in the dose of 0.08-0.1 mg per kg body weight was dissolved in Dimethyl Sulfoxide (DMSO) and was instilled in bladder of 11 patients (6 females and 5 males) suffering from severe or refractory BPS/IC and the solution was kept in bladder for 15-20 minutes. After removal of solution blood level of tacrolimus was measured in first seven patients. In first patient it was done after 12 hours and in other patients it was done 20- 30 minutes after removal of solution. Initial plan was to give 6 such instillations every 15th day. Pre instillation urine culture, CBC, Blood sugar and creatinine was done. RESULTS Only four patient completed all the 6 instillations. Two patients completed 3 instillations and five only one instillation. Patients refused instillations due to irritative effect of the solution which persisted for 24 to 48 hours. No other side effects were observed. Six patients who completed more than three instillations had no changes in blood count, serum creatinine and blood sugar levels. On seven point Global Response Assessment scale one patient had slight improvement, and 6 patient had markedly improvement. In 4 patients there was no change. The improvement persisted in follow-up averaging one year. Blood tacrolimus level was between 5.78 to 7.97 in tested patients. CONCLUSIONS Presence of Tacrolimus in blood proves that tacrolimus is absorbed from human urinary bladder. 15th day instillation of 0.08-0.1 mg Tacrolimus per kg body weight till 6 instillations is safe and effective. DMSO may have an additive effect in improvement. There is need for randomized study to prove effectiveness of Tacrolimus in BPS/IC © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e317-e318 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Nagendra Nath Mishra More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...