Photodynamic Therapy of Chronic Interstitial Cystitis in Geriatric Patients

Relevance. Treatment of chronic interstitial cystitis is one of the acute problems of modern urology. The development of new treatment options for this disease is necessary to optimize results and improve the quality of life of patients.

Aim. To analyze the results of photodynamic therapy for chronic interstitial cystitis in geriatric patients.

Materials and methods. The study was conducted on 45 patients over the age of 65 with chronic interstitial cystitis to examine the short and long-term effects of treatment. The main group consisted of 25 patients who received intravesical photodynamic therapy in combination with traditional antibacterial and anti-inflammatory treatment. In turn, the control group enrolled 20 patients who were treated with traditional therapy only. Patients must have met the following inclusion criteria to be eligible for participation in this study: the presence of chronic interstitial cystitis manifestations at least 3 times a year, morphological confirmation of interstitial cystitis. The study used clinical, laboratory, and instrumental research methods. To objectively assess the clinical symptoms of the disease initially, in the immediate and long-term periods after the start of treatment, the index of symptoms/problems of interstitial cystitis was used. Prior to the study and treatment, patients engaged in a discussion regarding the purpose and outcomes of diagnostic and therapeutic procedures, as well as their potential benefits and risks. Following this, the patients provided their informed consent by signing the necessary documents. For photodynamic therapy, the photosensitizer Photoditazine was administered intravenously 2 hours before the procedure at a dose of 0.8 mg/kg. Cystoscopy was performed. Using a quartz-polymer light guide, laser irradiation of the mucous membrane of the bladder was carried out with a wavelength of 661 nm, in a continuous mode, with a power of 2 W, an energy density of 25 J/ cm2, and an exposure time of 30 minutes. The dynamics of clinical and laboratory (leukocyturia, bacteriuria) parameters were assessed.

Results. In terms of clinical progress, the main group saw improvement after three to four days, while the control group showed improvement after five to seven days of treatment. Leukocyturia in the main group decreased significantly on the third day, disappeared on the seventh day, meanwhile in the control group it remained at the upper limit of normal. On the third day of treatment in the main group, bacteriuria decreased to 104 CFU/ml, in the control group — to 106 CFU/ml. On the seventh day, bacteriuria was not detected in the main group, while in the control group it remained at the upper limit of normal. The duration of hospital stay for patients in the main group was 7.5 ± 0.2 days, for the control group — 10.8 ± 0.3. Long-term results of treatment over a period of 15 to 22 months in the main group showed the absence of clinical and laboratory manifestations of the disease. In the control group, the manifestation of chronic interstitial cystitis was noted in 45% of patients and clinically significant leukocyturia and bacteriuria.

Conclusions. The results of the study demonstrated a higher effectiveness of photodynamic therapy in combination with antibacterial and anti-inflammatory treatment of patients with chronic interstitial cystitis compared to traditional methods.