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35th Annual Meeting of the International Continence Society
28 August – 2 September 2005, Montreal, Canada  

The Palais des Congrès, Montreal ’s convention centre with its colourful mosaic glass façade and unique forest of exotic "electric pink" tree trunks, formed the setting for ICS 2006. It was difficult to realise that Hurricane Katrina was meanwhile ravaging New Orleans and creating havoc throughout a vast area of the north coast of the Gulf of Mexico , affecting Louisiana , Mississippi and Alabama.


The International Continence Society, founded in 1971 as the "Continent Club", is a multi-disciplinary international society and this was reflected in the delegates attending the 35 th annual conference in Montreal . Urologists, gynaecologists, gastroenterologists, neurologists, physiotherapists, geriatricians, researchers, nurses and patient organisations from around the world were among the over 2500 delegates who converged on Montreal ’s Palais des Congrès.

Press Pack with fact sheets

The ICS is currently in the process of revamping its image, including the various forms of information it provides. This year a welcome new initiative was the Press Pack containing 10 fact sheets for the media on: Investigation of LUTS, Overactive Bladder, Stress Urinary Incontinence, Painful Bladder Syndrome (including IC), Pelvic Organ Prolapse, Faecal Incontinence, Neurological Bladder, Frail Elderly, Children’s Incontinence and a fact sheet about the ICS itself.We were particularly pleased to see a fact sheet on PBS/IC being distributed to the Press as this will undoubtedly help to raise awareness. In the past, IC tended to be ignored by much of the incontinence world and was treated rather like "Little Orphan Annie". Indeed its very existence was denied by some who considered patients to be ‘hysterical’ and painful bladder conditions to be "all in the mind". The reason for this denial was probably because the cause of this frustrating condition was – and still is - unknown, there was no treatment effective for all patients and their response to any kind of treatment appeared to be very individual. There seemed to be no logic to this painful bladder condition and of course little was then known or understood about complex pain mechanisms in the pelvic floor. However, the IC world is thankful to note that in recent years the tide has changed. IC, albeit under the umbrella name painful bladder syndrome, has now gained its rightful place in the world of the ICS. The fact that more and more research is being carried out into neurourology, generating new information every year about neurologic aspects of the bladder and pelvic floor and the relationship between innervation of the lower urinary tract and that of neighbouring organs has led to increasing new insights into PBS/IC and chronic pelvic pain syndrome. Suddenly the medical world is beginning to see where that elusive and inexplicable pain may be coming from.

Courses and workshops

This ongoing research into neurourology was reflected in some of the courses and workshops on offer in the 2 pre-conference days. We have selected just a few for comment.

Course 4 – Neurourology Advanced Course

A superbly presented course on the highly complex subject of neurologic function and dysfunction of the urinary tract. Its aim was to provide an up-to-date overview of knowledge in neurourology, its pathophysical basics, its epidemiology, diagnostic procedures, conservative and surgical treatment. This was followed the next day by Course 7 – Basic Neurourology.

Workshop 22 – Bladder and Bowel: Perfect Harmony or Conflicting Neighbours?

This was a most interesting workshop on the interrelationship between the lower urinary tract and the lower bowel tract, the innervation of both structures and neurologic problems that may occur. Problems in one may have a negative effect on the other. The presenters took as examples irritable bowel syndrome and interstitial cystitis and their mechanisms. Both the bladder and colon share similar autonomic innervation and sensory nerves. It was concluded that there is a need for scientific and clinical research workers in related specialties to collaborate and share understanding of the origin of pelvic pain. The neurological basis of chronic pelvic pain needs to be explored, particularly in relation to the way in which nerve dysfunction affects pelvic sensation and function. Since this workshop dealt with men and women, it did not discuss relationships and interactions with the third tract: gynaecological tract.

Workshop 26 – Clinical Presentation: Diagnosis and Management of Interstitial Cystitis

This workshop was unfortunately rather outdated and clearly underlined how important it is for those involved in education to stay abreast of the latest developments and changes in insight. In the past few years, these changes have been taking place at a rapid tempo. A further problem here was that drugs listed for treatment were mainly given as USA brand names only. In international presentations, generic names are essential. If not, many participants from around the world are left wondering what drug the speaker is referring to.

Workshop 27 – Interactive Workshop on Technique of Bladder and Sphincter Botulinum Toxin Injections

Botulinum toxin A (BTX-A ) was a hot topic this year at the ICS conference. This excellent workshop consequently attracted much interest. One section presented by Michael Chancellor MD concerned BTX-A for Interstitial Cystitis. This is still in its infancy but studies indicate a subjective improvement in a number of patients. The second half of the workshop was a practical session, allowing delegates to practise injecting BTX-A. Not into patients, I hasten to add, merely into oranges!

Workshop 18
also dealt with BTX A: Botulinum Toxin in the Overactive Bladder. This provided an overview of current knowledge on the mechanism of action and safety profile of BTX-A. One of the theories behind the use of BTX-A to treat pain is that it inhibits the release of local pain transmitters.

Continence Promotion Committee Workshop

The ICS actively promotes continence throughout the world and an important role here is played by the ICS Continence Promotion Committee (CPC) chaired by Diane Newman. The CPC increases awareness and knowledge about all aspects of incontinence around the world and facilitates communication and collaboration between the many national continence foundations and patient organisations worldwide. This committee consequently forms a direct link between the ICS and patients. This well-attended CPC workshop concerned "Current initiatives for Increasing Continence Awareness" and included discussions on a Continence Bladder Health Campaign and a week-long event in Europe. The CPC finds it alarming that a high percentage of incontinent patients do not seek medical help for their problem.

Press meeting – remove taboos

The above was also echoed at a press meeting when Jacques Corcos MD, this year’s conference chairman, emphasised that the ICS has to pull out all the stops to remove the taboo on incontinence around the world and encourage people to come out of hiding, admit to their condition and seek help.


Webcasts for armchair delegates

State-of-the-art and other presentations can be enjoyed from your armchair as a webcast: www.ttmed.com/urology/ics2005. If you don’t have the necessary software, it can be downloaded free from the site.

A state-of-the-art lecture of particular interest to us was the Urothelium as Sensory Organ in Normal and Pathologic Conditions by William C. de Groat. This excellent lecture (see webcasts) covered the history of neural-bladder interactions and the anatomy, barrier function, sensory properties and pathological changes of the urothelium. This is a very important field of research in lower urinary tract function and has a direct bearing on painful bladder syndrome/interstitial cystitis. There is increased interest in the urothelium and its possible neuronal-like functions because it is now becoming increasingly clear that the urothelium is more than just a barrier. The urothelium is a complex tissue with multiple functions. De Groat explained that the idea is emerging that the "urothelium can communicate with adjacent afferent nerves and that afferent/efferent nerves communicate with the urothelium via chemical messengers", that perhaps some kind of chemical dialogue is going on between urothelial cells and nerve fibres. The main message here is that urothelial cells are complicated and interact with each other.

We heard more about the conference hot topic botulinum toxin A (BTX-A) in this lecture. De Groat told delegates that BTX-A has now become a very important compound therapeutic agent in urology. BTX-A can inhibit the release of transmitters from efferent nerves as well as afferent nerves. In addition, the toxin inhibits the release of transmitters from urothelial cells. In a study by Barrick et al , 2005, intravesical injection of BTX-A was shown to increase bladder capacity and decrease urge incontinence in patients with overactivity. Other experimental studies conclude that BTX-A may alter bladder sensory mechanisms by acting on the urothelium. However, De Groat emphasised that everything is still based on a limited amount of evidence from a few studies. Much research is still needed and knowledge is constantly evolving.

N.B. Earlier this year in March an important symposium on Urothelial Cell Physiology in Normal and Disease States , chaired by Ricardo Saban MD, was organised in San Diego , USA and attracted researchers from around the world.

Posters and abstracts

The full text of all ICS 2005 abstracts can be viewed on the ICS website: www.icsoffice.org -> Abstracts

Fitzgerald MP, Koch D, Loyola University Medical Center

The study objective was to determine whether visceral hyperalgesia is present in patients with painful bladder syndrome, whether PBS patients have altered localisation of bladder sensation, whether repeated bladder filling alters the magnitude and location of perceptions of bladder filling, whether PBS subjects have lower thresholds to cutaneous stimulation than controls.

Patients were included in the PBS section (8 patients) of these studies if they had complained of bladder pain and urinary frequency, had O’Leary-Sant scores of at least 12 (IC Symptom Index) and 12 (IC Problem Index) and bladder pain had been present for at least 3 months. Patients were included in the Stress Urinary Incontinence section if they had urge incontinence but no pain and patient were included in the asymptomatic section if they had no symptoms of incontinence or bladder pain.

PBS patients demonstrated hyperalgesia to bladder filling. Second and third fills did not cause more pain than the first bladder fill. At maximum bladder capacity 6 PBS patients felt bladder fullness/discomfort at both suprapublic and vulvar sites.

The researchers concluded that their documentation of visceral and cutaneous hypersentitivity in this study supports the idea that PBS is a visceral pain syndrome. Full abstract text may be read on www.icsoffice.org.

Adorini L, Amuchastegui S, Aquilano F, Cossetti C, Matiani R, Penna G, Bioxell A.s.A. Italy

Chronic non-bacterial prostatitis or chronic pelvic pain syndrome (CPPS) is a highly prevalent syndrome of suspected autoimmune origin, characterised by chronic pelvic pain with varying degrees of urogenital symptoms. Based on the marked inhibitory activity of the vitamin D receptor agonist BXL-628 on basal and growth factor-induced proliferation of human prostate cells, and on its potent anti-inflammatory properties in different models, the researchers tested its capacity to treat experimental autoimmune prostatitis.

The results indicate that BXL-628, at non hypercalcemic doses, is able to interfere with key pathogenic events in already established experimental autoimmune prostatitis.

These data support the autoimmune pathogenesis of chronic non-bacterial prostatitis, and indicate that treatment with the VDR agonist BXL-628 may prove clinically beneficial in this syndrome. Full abstract text may be read on www.icsoffice.org.

Sand P [1], Zinner N [2]. 1. Division of Urology, Evanston Continence Center , Evanston , IL; 2. Western Clinical Research, Torrance , CA

The ICS currently defines urgency as a "sudden compelling desire to pass urine which is difficult to defer". Urgency has been referred to as one of the most bothersome symptoms of overactive bladder. The ICS definition only allows for a present/absent categorisation of urgency. However, use of an urgency severity scale that allows for discrimination in the severity of urgency may allow for more accurate measurement of changes in the urgency felt by patients undergoing antimuscarinic treatment. This study is intended to assess whether the current ICS definition is complete in describing the symptom of urgency, or if the use of an urgency severity scale may be required to allow for more accurate measurement of this symptom.

According to the researchers, the study has demonstrated that the current ICS definition may be incomplete in describing the symptom of urgency, and that use of an urgency severity scale with sufficient response gradation may be required to allow for more accurate measurement of this primary symptom. Based on their findings in this study, the authors feel that patient perceptions in urgency are sensitive to severity changes, and the ICS definition may require revision to incorporate this new understanding of patient perception. Full abstract may be read on www.icsoffice.org.

Abstract 104: UROTHELIAL BARRIER FUNCTION IN INTERSTITIAL CYSTITIS. Garthwaite M [1], Varley C [1], Marsh F [2], Ramage C [3], Urwin G [4], Eardley I [5], Trejdosiewicz L [6], Southgate J [1]
1. Department of Biology, University of York . 2. Department of Obstetrics and Gynaecology, St. James’s University Hospital, Leeds . 3. Department of Obstetrics and Gynaecology, Bradford Royal Infirmary. 4. Department of Urology, York Hospital . 5. Department of Urology, St. James’s Hospital, Leeds . 6. Cancer Research UK Clinical Centre, St. James’s University Hospital, Leeds.

The aim of this study was to investigate whether patients with IC have a defective urothelial differentiation programme leading to an ineffective or "leaky" urinary barrier that could be a major contributing factor in the development and progression of IC. These preliminary studies suggest that there are differences between normal and IC urothelium. The functional analyses demonstrate that cultured IC cells do not have the capacity to form an effective urinary barrier. These data suggest that an inherent abnormality of the urothelial cells may be a factor in the aetiopathology of IC. Full abstract may be read on www.icsoffice.org.

Van Ophoven A, Hertle L. Department of Urology, University Hospital, Münster, Germany.

The efficacy of amitriptyline (AMI) has never been assessed on a randomized, placebo-controlled, double-blind study until now. The authors additionally conducted a prospective open-label study to examine the safety and efficacy of long term administration.

In both trials treatment with AMI significantly improved the primary and most of the secondary outcome parameters in patients suffering from IC. Adverse events, although mostly mild and similar to those in previous reports, constitute the major drawback of this therapeutic approach to IC. The therapeutic long-term response to AMI was uniformly observed in patients fulfilling the NIDDK criteria and in those patients with the pure clinical diagnosis of IC.

The authors conclude that long-term AMI therapy is feasible, safe and effective for treating IC. Anticholinergic side effects are a key co-factor for treatment termination and constitute the major drawback of AMI treatment. Low starting doses and careful dosage titration including strict administration at bedtime may help to manage the side effects. Full abstract may be read on www.icsoffice.org.

Next ICS Annual Conference

The next annual ICS conference will be held in Christchurch, New Zealand, 27 November – 1 December 2006. www.ics2006.co.nz.

Jane Meijlink

updated 14.02.2006 16:02 © 2006-2018 International Painful Bladder Foundation (IPBF). All rights reserved.