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 5 mg 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 5 mg of tadalafil, for 3 months. Re-evaluations occurred at 4 and 12 weeks. Adverse events were assessed and recorded. Results: Urinary frequency, OSS, and QoL were significantly improved at 1-month follow-up (10 ± 2.5, 21.9 ± 4.1, and 4 ± 1.5, respectively, P < .05). Pain intensity and volume voided were significantly improved at a 3-month follow-up (3.5 ± 2 and 266.7 ± 60.5, P < .05). Patients referred to urinary frequency as the most important parameter improved at 4 weeks, and pain at 3 months. 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.