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3rd International Consultation on Incontinence
June 26-29, 2004 Monaco


ICI 2004 Monaco

The 3rd International Consultation on Incontinence was held at the Grand Hotel in Monte Carlo against the magnificent backdrop of mountains meeting the brilliant blue sea of the Mediterranean and its marinas of luxury yachts.


Committees


Experts on every aspect of incontinence had gathered here from all corners of the earth. Organised by the International Consultation on Urological Diseases (ICUD), the International Continence Society (ICS), the International Society of Urology (SIU) together with the major international association of urology and gynaecology, this was no congress of the usual kind. It was a workshop where 25 international committees reported on their findings and deliberations over the past year. The findings of the individual committees will be published in the form of chapters in a book of evidence-based recommendations. As described by ICI chairman Paul Abrams MD, the aim of each committee was to assess: What we know; What we think we know; What we don't know and What we need to know and to review the published evidence. The committees, divided into three broad categories: basic science, patient assessment and treatment, covered the following subjects: Epidemiology, Cell Biology, Neural Control, Pathophysiology (including pregnancy and childbirth), Basic Assessment, Symptom and Quality of Life Assessment, Dynamic Testing, Clinical Neurophysiological Testing, Imaging and Other Investigations, Drug Treatment, Children, Neurogenic Patients, Frail Elderly, Adult Conservative Management, Surgery for Urinary Incontinence in Men, Surgery for Urinary Incontinence in Women, Surgery Pelvic Organ Prolapse, Conservative Management of Faecal Incontinence, Faecal Surgery, Vesico-Vaginal Fistulas in the Developing World, Interstitial Cystitis, Technical Aspects of Continence Devices, Education and Continence Promotion, Economics of Incontinence and Research.


PBS/IC committee


The committee on Painful Bladder Syndrome/Interstitial Cystitis, chaired by Philip Hanno MD, comprised the following further members: Baranowski (UK), Fall (Sweden), Gajewski (Canada), Nordling (Denmark), Nyberg (USA), Ratner (USA), Rosamilia (Australia), Ueda (Japan). This committee faced a difficult and daunting task since much of the IC literature is anecdotal and based on case series while scientific evidence is thin on the ground. Furthermore, concepts and opinions on IC and its diagnosis and treatment vary greatly from one end of the globe to the other and treatment commonly used in one part of the world is not even approved in another. The committee believe that better epidemiological studies are now vital since all studies conducted so far have produced such widely divergent figures as to be unusable. No consensus has as yet been reached on either the name or the definition.


Future


There are many hypotheses regarding the etiology, but still no answers.

What do we need for the future? According to the committee, this includes a validated diagnostic marker; an evidence-based symptom-specific definition; we need to know more about the true incidence, prevalence , natural history and risk factors; we need to be able to differentiate PBS/IC from other forms of voiding dysfunction and bladder pain.

The pros and cons of biopsy were discussed: biopsy is essential for studies but is considered invasive and expensive for clinical diagnosis. At the moment there is a trend in the USA not to do biopsies, while Europe tends to consider it an essential part of the diagnostic workup. The committee considered it optional.

PBS/IC has a triad of symptoms: pain, frequency and urgency. Frequency is dependent on many factors, including the patient's drinking habits, and may therefore not always be meaningful. Urgency depends on how you define the term urgency.

Diagnosis is clinical and currently based on symptomatology and exclusion.

The committee does not recommend the potassium sensitivity test as a diagnostic tool as it is not considered reliable.

On the subject of bio-markers: the committee recommends that all findings of studies need to be replicated in laboratories worldwide.

None of the different symptom scales have been shown to be of value for diagnosis, but may be of value to follow the clinical course of the disease and the response to treatment.

The committee members felt that after extensively looking at the literature on treatment, they had the impression that almost every drug works for this disorder! The committee reached a consensus opinion on the value of the different drugs and treatments used for PBS/IC. This consensus opinion may well be felt to be controversial in some parts of the world when published.

On the subject of surgery: while complete cystectomy may ultimately be the only option for refractory patients, continent diversions can often lead to problems and recurrence of IC in the pouch can be a real possibility. Patients need to be thoroughly informed of all potential side-effects of surgical interventions.

The use of pain clinics and pain experts was recommended for the treatment of severe pain.

Recommendations for the direction of future research included better clarification of terminology used including a better definition of urgency.

I have merely been able to pick out a few main points from the very detailed presentation of this committee in Monaco. The final text is currently being prepared for publication, taking into account all questions and comments raised at the meeting. We will of course let you know when it is available.

At the end of the presentation by Philip Hanno, Paul Abrams (UK) from the ICI and ICS also briefly dwelt on the issue of urgency and PBS/IC and suggested that perhaps a different term should be used for these painful bladder patients, with the term urgency reserved for patients with incontinence.


Urgency & Urge


The issue of urgency indeed cropped up many times in other presentations and satellite symposiums during the conference. Christopher Chapple (Sheffield, UK) suggested that a clear distinction needs to be made between the terms urge and urgency. These two terms have until now been used interchangeably. He claimed that the urge to urinate is a normal sensation while urgency is an abnormal sensation.

And this terminology issue equally well applies of course to the IC world where the symptoms of IC are sometimes described as “pain, urge, frequency” and other times “pain, urgency, frequency”.

On the subject of urgency and IC, I was left with the clear impression at the end of the conference that it is now imperative to carry out studies into the nature of urgency in IC and its cause or causes and into whether or not these differ from urgency as experienced in overactive bladder syndromes. Only after answers have been produced to these questions should terminology and definitions be considered.


IICPN Foundation information table


The ICI committee kindly allowed the IICPN Foundation to have a complimentary IC information table in the exhibition room. We were given a perfect location right by the door through which every participant had to pass to reach the auditorium. Bearing in mind that this was a relatively small select conference attended by something in the region of 900 participants, the amount of information on IC and associated disorders that we distributed was amazing: more than 1600 items of information were taken away! And that was not counting the doctors who just took away the details of our website (www.iicpn-foundation.org). As you can see from the photo, the IC info table attracted a great deal of attention and interest from participants all over the world. It once again clearly showed the value of info tables and the need for even the most basic information to be made available. A lot of interest was shown in the information on IC and gastrointestinal disorders and IC and associated disorders (including Sjögren's syndrome) and also in vulvodynia (there were of course many gynaecologists participating). It is perhaps worth mentioning the website of the American National Vulvodynia Association here once again: www.nva.org. Excellent information on vulvodynia is available on this site.
 

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The IICPN information table attracted a great deal of attention and interest from participants all over the world  
 

Many thanks to the ICI committee for allowing us the complimentary stand space and to our sponsor Medtronic for making it possible for us to participate and distribute so much information. As we packed up to go home – and this did not take very long as we had distributed all our literature! - we felt that this had been an exceedingly worthwhile project.

Jane Meijlink

 
 
   
updated 10.02.2006 15:00 © 2006-2018 International Painful Bladder Foundation (IPBF). All rights reserved.