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Evaluating Evolving Treatment Pathways for Interstitial Cystitis/ Bladder Pain Syndrome (IC/BPS) Utilizing Multi-Institutional Data from TriNetX
Cedrick B. Chiu, BS
1,
Benjamin E. Rubin, BS2, Jennifer Anger, MD, MPH
3.
1UMass Chan Medical School, Worcester, MA, USA,
2University of Vermont, Burlington, VT, USA,
3UC San Diego Medical Center, La Jolla, CA, USA.
BACKGROUND: IC/BPS severely impacts quality of life. Despite various treatment options recommended by AUA and SUFU, success rates are low, with many patients expressing many therapies fail to provide consistent relief. This study uses a multi-institutional research database to evaluate evolving treatment pathways for IC/BPS, with a focus on differences between sexes.
METHODS: A retrospective cohort analysis of IC/BPS patients from 2005 to 2024 was conducted using the TriNetX US Collaborative network. The data were divided into four five-year intervals, and patients were grouped by treatment type: observation, single therapy, or multiple therapies. Demographic data, including age and sex, were analyzed. Independent t-tests compared treatment patterns between sexes and logistic regression assessed trends over time.
RESULTS: 111,344 IC/BPS patients were identified, with 92.3% female and 7.7% male. Observation was the most predominant treatment strategy, used in 48.6% of cases, while single therapies, primarily oral medications, accounted for 53.2% of treated patients. Females were more likely to receive behavioral (7.1% vs. 3.8%) and intravesical (11.4% vs. 6.7%) therapies compared to males (p < 0.05), whereas procedural interventions, like bladder hydrodistension, were more common in males (10.8% vs. 5.9%, p < 0.05). Although major surgeries such as cystectomy and ileal neobladder are infrequent, their prevalence increased from 0.5% in 2005-2009 to 1.2% in 2020-2024 (p < 0.05). The use of multiple therapies rose from 6.3% to 14.8% (p < 0.05). Logistic regression showed a significant decrease in the average age of treatment initiation (slope = -2.7, p = 0.004), suggesting earlier diagnosis and intervention.
CONCLUSIONS: Over the past two decades, IC/BPS treatment pathways have evolved, with notable sex-based differences in management approaches. Despite increased use of various therapies and a trend toward earlier intervention, the ongoing challenges in achieving consistent symptom relief highlight the need for continued research and innovation in treatment strategies.
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