What Is Cystilieve?

Cystilieve is a prescription bladder instillation treatment designed specifically for people with interstitial cystitis (IC) or painful bladder syndrome (PBS) who have not found relief through other treatments. The product is available in the UK as a “special” medication, meaning doctors can order it specifically for named patients through compounding pharmacies.

The treatment contains two active ingredients that have been used in medicine for decades: lidocaine, a local anaesthetic, and sodium bicarbonate, which adjusts the pH level. What makes Cystilieve distinctive is not the ingredients themselves but rather how they are combined and administered to maximise absorption into the bladder wall.

I should be upfront about something: this is a relatively niche treatment option that sits within a broader category of intravesical (inside-the-bladder) therapies. It is not a first-line treatment, and the published research on alkalinised lidocaine specifically is more limited than for some other bladder instillation options.

How Does Alkalinised Lidocaine Work?

The basic principle behind alkalinised lidocaine is straightforward. Lidocaine is a local anaesthetic that blocks nerve signals, temporarily numbing the area where it is applied. When instilled into the bladder, lidocaine can reduce the pain signals coming from an irritated bladder lining.

Here is where the pH adjustment comes in: lidocaine is more readily absorbed through tissues when the surrounding environment is more alkaline (higher pH). The sodium bicarbonate raises the pH of the bladder contents, which helps the lidocaine cross from the urine into the bladder wall tissue where it can actually do its job.

Without the alkalinisation step, much of the lidocaine would simply sit in the acidic urine without being absorbed effectively. The sequential instillation—first adjusting the pH, then introducing the lidocaine—is what makes this approach different from simply putting lidocaine solution into the bladder.

My understanding: The treatment works by essentially creating better conditions for the anaesthetic to reach the inflamed bladder tissue. It is not curing the underlying condition but rather providing symptom relief by blocking pain signals at the source.

What Does the Research Show?

The clinical evidence for alkalinised lidocaine in IC/PBS comes from several studies, though I would characterise the overall evidence base as promising but still developing.

The PSD597 Trial

The most rigorous published study on this specific approach was a randomised controlled trial of PSD597 (a branded alkalinised lidocaine product) published in the journal BJU International 1. The trial enrolled 102 patients with IC/PBS across 19 centres in the United States and Canada.

Patients received either PSD597 (200 mg lidocaine alkalinised with 8.4% sodium bicarbonate) or placebo daily for five consecutive days. The results were statistically significant: 30% of patients treated with the alkalinised lidocaine rated their symptoms as moderately or markedly improved three days after completing treatment, compared to 9.6% in the placebo group.

What caught my attention was that the benefits persisted beyond the immediate treatment period. Lidocaine’s anaesthetic effect typically wears off within hours, yet patients reported sustained relief days after the instillation course ended. This suggests the treatment may do more than simply numb pain temporarily—it might help calm overactive nerve signalling in the bladder.

Combination Approaches

Several studies have examined alkalinised lidocaine combined with other agents, particularly heparin. A study in the journal Urology found that combining heparin with alkalinised lidocaine significantly outperformed lidocaine alone 2.

After a single instillation, 75-94% of patients reported significant immediate symptom relief. The combination reduced bladder pain (38% versus 13% for lidocaine alone) and urgency (42% versus 8%). Importantly, symptom relief lasted beyond what you would expect from the anaesthetic effect alone—up to 12 hours in some patients.

A longer-term study using 12 weekly instillations of heparin and alkalinised lidocaine found that 76% of patients responded at the end of treatment, with response rates of 90% at one month, 46% at two months, and 16% at six months after treatment ended 3.

Reality check: These numbers tell an honest story. The treatment provides real benefit for many patients, but the effects do tend to diminish over time. This is consistent with what we see with other bladder instillation therapies—they often need to be repeated periodically to maintain symptom control.

The Continuous Release Device

An interesting development was the LiRIS system—a small device placed in the bladder that continuously releases lidocaine over two weeks. A pilot study in Science Translational Medicine showed clinically meaningful reductions in pain, urgency, and voiding frequency 4.

What particularly interested me was that cystoscopic examination showed visible improvement in the bladder lining, and in five of six patients with Hunner’s lesions (ulcers on the bladder wall), the lesions resolved during the treatment period. The overall responder rate was 64%, maintained for several months after device removal in some patients.

This device approach is still experimental and not widely available, but it addresses one of the practical limitations of standard instillation therapy: the need for frequent clinic visits.

Who Might Benefit from Cystilieve?

Based on the clinical evidence and treatment guidelines, alkalinised lidocaine instillation is generally considered for patients who:

Have a confirmed diagnosis of interstitial cystitis or painful bladder syndrome
Have not responded adequately to conservative treatments (dietary changes, stress management, oral medications)
Are willing and able to attend clinic appointments for the instillation procedure
Do not have contraindications to lidocaine

The treatment is typically positioned as a second or third-line option, not something to try before simpler approaches. If you have just started experiencing bladder spasms or pelvic discomfort, your doctor will likely want to rule out other causes like bacterial cystitis or urinary tract infections first.

Worth noting: IC/PBS is notoriously difficult to treat, and what works for one patient may not work for another. Some people find intravesical therapies transformative; others get minimal benefit. There is no reliable way to predict who will respond well beforehand.

What Is the Treatment Process Like?

The instillation procedure itself is relatively quick, though it does require attending a clinic. Here is what typically happens:

A thin catheter is inserted through the urethra into the bladder
The bladder is first instilled with sodium bicarbonate solution to raise the pH
After a brief dwell time, the lidocaine solution is instilled
The catheter is removed
You hold the solution in your bladder for a specified time (usually 30-60 minutes)
You then void normally

Most treatment protocols involve multiple sessions. The PSD597 trial used five consecutive daily treatments. Other protocols use weekly treatments for 6-12 weeks. Some patients then receive maintenance treatments at longer intervals.

I will not pretend the catheterisation is pleasant, but most patients tolerate it well. The actual instillation is painless—you might feel some fullness or mild urgency as the bladder fills.

Side Effects and Safety Considerations

Lidocaine is one of the most widely used local anaesthetics in medicine, with a well-established safety profile. When used intravesically at standard doses, systemic absorption is minimal, meaning you are unlikely to experience the side effects sometimes seen with oral medications.

The main considerations include:

Local effects: Some patients experience temporary worsening of urgency or discomfort immediately after instillation. This usually settles quickly.

Catheterisation risks: As with any catheterisation, there is a small risk of urinary tract infection or urethral irritation.

Lidocaine allergy: Rare but important to check before treatment if you have had reactions to local anaesthetics before.

Drug interactions: Lidocaine can interact with certain heart medications and other drugs. Your doctor will review your medications before prescribing.

Worth mentioning: Because the sodium bicarbonate solution raises urine pH, there are theoretical concerns about interactions with certain medications that are affected by urinary pH. This is something to discuss with your prescriber.

How Does Cystilieve Compare to Other Treatments?

Bladder instillation therapy is just one category among many treatment options for IC/PBS. Other approaches include:

Oral medications: Pentosan polysulfate (Elmiron), amitriptyline, antihistamines, and others. These avoid the need for catheterisation but may have systemic side effects.

Other instillation therapies: Hyaluronic acid (aimed at restoring the bladder’s protective layer), dimethyl sulfoxide (DMSO), heparin, and various combination cocktails.

Physical therapies: Pelvic floor physiotherapy can help many patients, particularly those with associated pelvic floor dysfunction.

Procedures: Bladder hydrodistension, Botox injections, and in severe cases, surgical options.

I cannot tell you that alkalinised lidocaine is better or worse than these alternatives because the comparative evidence is limited. What I can say is that it offers a different mechanism of action (primarily pain relief through nerve blockade) compared to approaches aimed at coating or healing the bladder lining.

My honest assessment: For patients with significant pain as their predominant symptom, lidocaine-based approaches may be particularly worth considering. For those whose main issue is frequency or urgency without severe pain, other instillation options might be more appropriate.

Practical Considerations in the UK

Cystilieve is available in the UK as a “special” medication prepared by compounding pharmacies. This means:

Your urologist or specialist needs to prescribe it specifically for you
It is not a standard pharmacy stock item
Availability may vary depending on your region and clinical commissioning arrangements
Treatment will typically be administered at a hospital or specialist clinic

The cost and NHS availability can be complex to navigate. If your specialist believes you would benefit from this treatment, they should be able to advise on the pathway for obtaining it in your area.

Questions to Ask Your Doctor

If you are considering alkalinised lidocaine treatment, here are some questions worth discussing:

Is my diagnosis confirmed, and have simpler treatments been tried first?
What treatment protocol would you recommend (number of treatments, frequency)?
What is the realistic chance of benefit based on my symptoms and history?
How would we measure whether the treatment is working?
If it helps, how long might the benefits last, and what would maintenance treatment look like?
Are there any reasons why this treatment might not be suitable for me?

Final Thoughts

Alkalinised lidocaine bladder instillation, whether as Cystilieve or similar formulations, represents one tool in the treatment toolkit for interstitial cystitis and painful bladder syndrome. The research shows it can provide meaningful symptom relief for a substantial proportion of patients, particularly when combined with agents like heparin.

However, I want to be realistic: this is not a cure, and benefits often require repeated treatments to maintain. The condition itself remains poorly understood, and treatment response varies considerably between individuals.

If you have been struggling with IC/PBS symptoms and have not found adequate relief from other treatments, alkalinised lidocaine instillation is worth discussing with your specialist. Just go in with realistic expectations—it may help significantly, it may help modestly, or it may not be the right approach for you.

References

Nickel JC, et al. Intravesical alkalinized lidocaine (PSD597) offers sustained relief from symptoms of interstitial cystitis and painful bladder syndrome. BJU Int. 2009;103(7):910-8. PubMed
Parsons CL, Housley T, Schmidt JD, Lebow D. Successful downregulation of bladder sensory nerves with combination of heparin and alkalinized lidocaine in patients with interstitial cystitis. Urology. 2005;65(1):45-8. PubMed
Nickel JC, et al. Alkalinized lidocaine and heparin provide immediate relief of pain and urgency in patients with interstitial cystitis. J Urol. 2012;182(5):2123-6. PubMed
Lee JY, et al. Continuous intravesical lidocaine treatment for interstitial cystitis/bladder pain syndrome: safety and efficacy of a new drug delivery device. Sci Transl Med. 2012;4(143):143ra100. PubMed