Hypothesis / aims of study
Instillation of chondroitin sulphate (CS) in the bladder is one of the cornerstones in treatment of Bladder Pain Syndrome (BPS). CS is instilled into the bladder via a catheter and contributes to the repair of a defective GAG layer. Treatment is administered in weekly sessions over a course of 6 weeks. Many hospitals let patients come to the institution and have a nurse do the catheterization and instillation (nurse provided instillation, NPI). We have for several years taught patients to perform clean intermittent self catheterization (CISC) and let them do self instillations (SI) in their own home. We have, however, never evaluated the treatment systematically.
To find out if treatment results depend on whether patients do SI or NPI and to evaluate whether patients had any preference at the end of treatment. Finally we wished to estimate possible differences in resources spent for both patients and nurses.
Study design, materials and methods
The study was a randomized cross-over study with a treatment period of 12 weeks. Patients were randomized to either 6 weeks SI followed by 6 weeks NPI (SI/NPI group) or 6 weeks NPI followed by 6 weeks SI (NPI/SI group). Before starting SI patients were trained in accordance with the department´s instructions on CISC during their first visit. Patients were allowed to contact our clinic at any time during the treatment period. During NPI patients came to the clinic once every week. Twenty patients were included in the study, ten in each group.
All patients kept a daily record of pain, urgency and number of daily voiding. Upon inclusion in the study, patients filled in a questionnaire. This was filled in again after 6 and 12 treatments. For the evaluation of possible treatment differences between NPI and SI treatment results were evaluated after the initial six weeks. For the evaluation of the remaining parameters results after 12 weeks’ treatment were used
Interpretation of results
It appears that NPI give better treatment results than SI when looking at self-reported bladder symptoms like pain, urgeny and number of voidings. The better treatment results are, however, not reflected in results regarding treatment satisfaction and patients’ preferences regarding treatment modality. All patients preferred to do SI as opposed to NPI despite the better treatment results and the possibility of having a consultation with a health care professional when given the NPI. UTI is a complication related to SI, probably indicating a learning curve for the patients performing CISC