Bladder Instillation for Treatment of Interstitial Cystitis
Ambulatory Care (AC)
last reviewed December 21, 2016*
This procedure is performed to relieve the symptoms of interstitial cystitis, for which the cause and cure are not known. The procedure involves guiding a catheter up the urethra into the bladder. A measured amount of solution (e.g., dimethyl sulfoxide) is then passed through the catheter into the bladder, where it is retained for a specified amount of time (usually 15 minutes) before being expelled. Treatments with this procedure can be performed in the physician’s office or at home for individuals who are willing to catheterize themselves and do self-administration with physician approval.
Clinical Indications for Procedure
Bladder instillation may be indicated for ALL the following:
Documented diagnosis of interstitial cystitis with ALL of the following:
Urinary frequency during the day and/or night
Pain related to the bladder and/or pelvic area
Absence of other diseases that could cause the symptoms
Documentation of a hydrodistention cystoscopy that supports the diagnosis of interstitial cystitis
Goal Length of Stay - Ambulatory
Note: Typically performed as office procedures but can also be performed at home by Home Health.
American Academy of Family Physicians. (2011, May). Interstitial cystitis/painful bladder syndrome. Retrieved August 26, 2013 from http://www.aafp.org/afp/2011/0515/p1175.html?printable=afp.
American Urology Association. (2014, September). Diagnosis and treatment of interstitial cystitis /bladder pain syndrome. Retrieved August 30, 2016 from https://www.auanet.org/common/pdf/education/clinical‐guidance/IC‐Bladder‐Pain‐Syndrome‐Revised.pdf.
BlueCross BlueShield of Tennessee network physicians. September ‐ December 2016.
Centers for Medicare & Medicaid Services. CMS.gov. NCD for Dimethyl Sulfoxide (DMSO) (230.12). Retrieved August 30, 2016 from https://www.cms.gov/medicare‐coverage‐database/details/ncddetails.aspx?ncdid=149&ver=1.