Two Cases of Cystoscopy proven Interstitial Cystitis (with granulations) attained 100% relief of bladder pain with 3 mls 1% lidocaine and 40 mg kenalog injected caudally. Both had obvious tarlov cysts in sacrum casing sacral nerve irritation but makes one wonder if this would help causes with other forms of low back sciaticas.
Pain Physician. 2012 Mar;15(2):141-6.
Minimally invasive interventional therapy for tarlov cysts causing symptoms of interstitial cystitis.
Freidenstein J, Aldrete JA, Ness T. free article here
- [Re tarlov cysts]- “It has been our experience that a subset of patients may have associated pelvic pain and urinary dysfunction which can often be confused with interstitial cystitis (IC).”
- “pain of IC can extend throughout the pelvis and into the urethra, vulva, vagina, and low back”
- “presence of pain for greater than 6 weeks and the lack of a readily identifiable cause” (UTI and endometriosis)
- “Once secondary causes are ruled out, the patient will usually undergo urodynamic studies” – WOW – this is skipped in the town but sounds like a good idea! – I have one case that sound more like a overdrinking issue and a spastic bladder issue may not exist…
- Early management – pentosan polysulfate, amitriptyline, or other antineuropathic agents
- Mid management – interventional treatments such as cystoscopy with hydrodistention or intravesical instillation of treatment solutions
- Late management – neuromodulation, cyclosporine A, and intradetrusor botulinum toxin.
- Last resort – Surgical urinary diversion or cystectomy
- Tarlov cysts are most commonly between S1-4 in the nerve root where separates the dorsal ganglion, and are filled with CSF fluid
- They occur in 4.6 – 9 % of the population and about 10% of them will become symptomatic in life.
- 86.5% of symptomatic cysts are women and 53.7% find the pain severe. – I was not aware how bad they could be..
- In both cases, the cysts were bigger than 1.5 cm
- The caudal was done with minimal penetrationmof caudal canal to avoid puncture cyst (who cares?) – then 3 mls 1% lidocaine and 40 mg kenalog was injected. Both had injections repeated several times – one at 6 month interval.
- Both patients attained nearly 100% relief of pain for a period ranging from 6 months to 2 years
Comment – Both had definite granulations on Cystoscopy – one was severe. This makes me very suspicious that Interstitial cystitis is more neurogenically driven rather than a loss in integrety of mucous membranes in bladder. Mast cells are attracted by neurogenic inflammation so could be a seconday phenomenon… ie occur after the fact and not cause the problem. One is left with the sinking feeling that a caudal block of 3 ml 1% lidocaine and 40 mg kenalog should be used in all cases of interstitial cystitis with significant back pain – MRI’s are nice but strictly regulated in Canada by radiologists who feel they own the machines – grrrr. When you ask for an MRI from the radiologist – you do not get a facilitator – you get what is known as a “blocker”…
Given that these cases had caudals that went minimally into caudal canal, it would almost be a deep subcutaneous injection – a 2 inch 25 guage needle would do and even then, don’t have to push it up much…