Daily low dose of tadalafil improves pain and frequency in bladder pain syndrome/interstitial cystitis patients

Objective: Bladder pain syndrome/interstitial cystitis (BPS/IC) is a chronic disease, with consequent high morbidity. Increasing evidence suggests that bladder afferent hyperexcitability, through neurogenic bladder inflammation and urothelial dysfunction, plays a key role in the pathophysiology of BPS/IC. The rationale of using phosphodiesterase type 5 inhibitors (PDE5i) would be to decrease bladder afferent hyperactivity. Detrusor relaxation, improvement of microcirculation, and a decrease in adrenergic nociceptive overactivity would be other effects in bladder tissue. We aimed to evaluate the efficacy, tolerability, and safety of a daily low dose of 5mg tadalafil in refractory BPS/IC patients. Material and methods: A total of 14 refractory BPS/IC female patients, previously evaluated with a physical examination, bladder diary, bladder-pain related visual analogue score, O'Leary-Sant Scores (OSS) for symptoms and problems, and quality of life (QoL) question from International Prostate Symptom Score, were treated with 5mg of tadalafil, for 3months. Re-evaluations occurred at 4 and 12weeks. Adverse events were assessed and recorded. Results: Urinary frequency, OSS, and QoL were significantly improved at 1-month follow-up (10 6 2.5, 21.9 6 4.1, and 4 6 1.5, respectively, P < .05). Pain intensity and volume voided were significantly improved at a 3-month follow-up (3.5 6 2 and 266.7 6 60.5, P < .05). Patients referred to urinary frequency as the most important parameter improved at 4weeks, and pain at 3months. No differences between ulcerated and nonulcerated patients were observed. Two patients dropped out due to unsatisfactory results and two due to persistent headache and/or tachycardia, but both events were resolved after discontinuing the drug. Conclusion: Daily low-dose tadalafil is an easy, well-tolerated, and effective treatment for refractory BPS/IC in women.