IPBF: who are we ?

 
site map  
interstitial cystitis &
bladder pain syndrome (IC/BPS)
 
Hunner lesion  
hypersensitive bladder  
other pelvic pain conditions  
overactive bladder syndrome  
associated disorders  
the urinary tract: how it works  
news & reviews  
literature: selected topics  
IPBF newsletters  
IPBF publications  
information in other languages  
glossary of terms: A-Z  
information for professionals  
books, videos, CDs  
calendar  
how to start and run a support group  
surveys  
global IC/BPS support groups, contact persons and related organizations  
donations & sponsoring  
useful links  
disclaimer & copyright  
   
   
 

 

American Urological Association (AUA) annual meeting
Georgia World Congress Center, Atlanta, USA,
May 20-25, 2006

 

Founded in 1837 as the terminus of the Western & Atlantic railroad line, Atlanta is today a rapidly growing, ultra-modern metropolis, the birthplace and boyhood home of Martin Luther King, headquarters of the CNN studios, and in 1996 host to the Olympic Games. From 20-25 May, Atlanta formed the backdrop to the 2006 annual meeting of the American Urological Association (AUA) with over 14,000 attendees of whom 51% were international participants from countries around the globe.
All those with a special interest in painful bladder syndrome/interstitial cystitis at the annual conference of the American Urological Association in Atlanta were constantly hurrying from one end of the vast Georgia World Congress Center to the other to attend the unprecedented number of presentations on PBS/IC which has recently become such a hot topic at conferences. Posters, courses, press briefing, society meeting sessions, cystoscopy video… there was scarcely time to catch your breath! And everywhere you went, you bumped into many of the well-known faces from the PBS/IC world from innumerable different countries. It was nevertheless gratifying to see many new faces from all around the world attending the two courses presented on this topic. This will help to ensure continuity in future years.


 
IPBF coverage of the AUA  
Representatives from the International Painful Bladder Foundation reporting on this AUA meeting were Jane Meijlink from the Netherlands and Dr Nagendra Mishra from India.
  Photo: Nagendra Mishra MD, Robert Moldwin MD and Jose Luis Campos MD
   
Terminology and definitions still a problem

It was evident from the AUA conference presentations on PBS/IC that terminology is one area that still needs a lot of attention. As you will see from this report, some people are using the term IC/PBS, others PBS/IC, some researchers entitle their paper Interstitial Cystitis while others refer to everything as Painful Bladder Syndrome. It is to be hoped that this terminology confusion will be resolved before too long. In this report, we have kept to the terminology as used by the individual presenters in their titles, but otherwise use the term PBS/IC. As we went from one presentation to the other, it was also evident that there are many different concepts regarding how PBS/IC should be defined and interpreted and many different diagnostic approaches.

 

Satellite Symposium

Our planes had scarcely touched down in the heat of Atlanta when it all started. A pre-conference satellite dinner symposium was held on the evening of Friday 19 May entitled Managing Interstitial Cystitis/Painful Bladder Syndrome: A case-based approach to simplifying the complex, with John B. Forrest MD and J. Curtis Nickel MD. It was emphasized that doctors should take care to differentiate between chronic pain in the bladder and pelvic pain. According to the speakers, before considering a diagnosis of PBS/IC, the following conditions should be excluded: endometriosis, urinary tract infection, pelvic inflammatory disease, pelvic adhesions, ovarian pathology, vaginal infections, vulvodynia, uterovaginal prolapse, urethral pathology, pelvic floor dysfunction and irritable bowel syndrome. On the other hand, some of these disorders may be present at the same time as PBS/IC. [For a more extensive list of confusables, see website of the European Society for the Study of IC: www.essicoffice.org, ESSIC Consensus Report on Definitions and Confusables].

Dr Curtis Nickel described the diagnostic and treatment implication of the alkalized lidocaine intravesical anaesthetic for PBS/IC first described by Henry and Nickel in 2001. Alkalization provides safe and predictable lidocaine absorption into the bladder. If, when this anaesthetic is instilled into the bladder, the pain stops, it is an indication that the pain is indeed located in the bladder and not elsewhere. The suggested recipe is: 10 cc of 1-2% lidocaine diluted in 10 cc of 8.4% bicarbonate solution. It can also be used as a rescue treatment in a severe flare. As in other presentations, it was underlined here that a lack of glomerulations during cystoscopy does not necessarily exclude PBS/IC. The profound effect of PBS/IC on social and sexual relationships was underlined in this symposium, with loss of interaction with the family leading to isolation of the patient. PBS/IC can potentially have a disastrous effect on work with the patient missing days off work or even being forced to stop completely.

 
SOCIETY FOR BASIC UROLOGIC RESEARCH (SBUR):
Session II: New Advances in Interstitial Cystitis
   
The AUA annual conference started with the specialized society meetings and of particular interest was the Breakout Session II of the Society for Basic Urologic Research. This session concerned: New Advances in Interstitial Cystitis, chaired by Dr Susan Keay
  Photo: Susan Keay presiding over the SBUR Session II
 

Basic research was presented by David J Klumpp, PhD from Feinberg School of Medicine on: TNF alters bladder function in neurogenic cystitis (see also abstract 288 below), Naoki Yoshimura MD, PhD from Pittsburgh on gene therapy and botulinum toxin, Jordan Dimitrakov MD, PhD from Harvard Medical School Urological Diseases Research Center on Genetic Insights into Interstitial Cystitis; Tony Buffington, DVM, PhD from Ohio State University Veterinary Hospital on his latest research with feline PBS/IC (co-morbidity & behaviour, adrenal issues, effects of stress, effects of treatment).

According to Dr Jordan Dimitrakov, current hypotheses concerning the etiology of PBS/IC include: Epithelial, Abnormal mast cell activity, Neurogenic inflammation, Reflex sympathetic dystrophy, Autoimmunity, Genetic. Dr Dimitrakov presented the first evidence for genetic linkage in families with high prevalence of IC. He suggested that multiple linkage peaks imply more heterogeneity within the population than hypothesized. Diseases such as PBS/IC may be a question of genetic predisposition plus environmental components.

 
Botulinum Toxin-A

The presentation by Dr Naoki Yoshimura  during this SBUR meeting included gene therapy and the use of Botulinum Toxin-A (BTX-A) for pain. Until now, BTX-A has mainly been used urologically for the treatment of urgency/frequency in overactive bladder. However, studies in other fields have indicated that it may have a role to play in reducing pain. In 2001 postherpetic neuralgia was successfully treated by subcutaneous injection of BTX-A (Freund et al, 38th interagency botulinum research coordinating committee meeting, October 17-19, 2001), while Jabbari et al reported that burning pain and allodynia in two patients with spinal cord pathology were relieved by subcutaneous injection of BTX-A in 2003. More recently small trials have been performed with PBS/IC patients. In 2004, Smith et al found that daytime frequency, nocturia and pain VAS decreased by 44%, 45% and 79% in a small study with 13 IC women in the USA and Poland. They presented evidence that BTX-A has antinociceptive effects in treating IC. Dr Yoshimura suggested that there may be a direct effect of BTX-A on noncholinergic neurons, resulting in reduced release of substance P, CGRP [calcitonin-gene related peptide], glutamate and other substances. Dr Yoshimura said that more and larger studies are now needed with PBS/IC patients. BTX is simple to use, has no apparent toxicity, has long-term effects (3-6 months), local expression and can be repeated when necessary. However, Dr Yoshimura suspects that the variation in results from trials so far may depend on such aspects as the site and method of injection. Dr Yoshimura explained that his team is now experimenting with injections of Botox into the urothelium of animals, i.e. into the surface of the bladder and not into the muscle. They believe that this may prevent the retention problems experienced by some patients undergoing Botox treatment. The aim is not to affect the motor function. Dr Yoshimura’s proposed etiology of IC is as follows: Bladder insult -> Epithelial damage -> Potassium leak into interstitium -> Activation of C-fibers and release of substance P -> Mast cell activation and histamine release -> more injury. In other words it becomes a vicious circle.

 
SOCIETY FOR INFECTION & INFLAMMATION

Members of the Society for Infection and Inflammation were given a special lecture on PBS/IC by Dr C. Lowell Parsons from San Diego on: Interstitial Cystitis: a New Paradigm Emerging.

 
PRESS BRIEFING ON PBS/IC


Dr Kristene Whitmore chaired a press briefing on PBS/IC which covered a number of posters being presented at the AUA meeting, including abstract 278 on hyperbaric oxygen therapy presented here by Dr Arndt van Ophoven from Germany and abstract 292 on the effect of comestibles on interstitial cystitis presented here by Dr Robert Moldwin. Other presentations at this briefing covered epidemiologic studies.
Photo: Kristene Whitmore MD  
 

STEM CELL TISSUE ENGINEERING for bladders – Dr Atala at the AUA
At the beginning of April this year, many of you will have seen headlines in your daily newspapers concerning a tissue engineering breakthrough involving bladder augmentation as published in the Lancet (“Tissue-engineered autologous bladders for patients needing cystoplasty”). Here in the Netherlands it was front page news in the national newspapers, while in India Dr Nagendra Mishra received phone calls from his excited PBS/IC patients asking when they could have a new bladder. And doubtless many other urologists around the world had the same experience.
We therefore took advantage of the AUA special roundtable expert session for the Press to speak to Dr Anthony Atala himself, together with Hannes Strasser MD, Michael Chancellor MD and Larissa Rodriguez MD, to find out what the true situation is exactly behind all the media sensationalism surrounding stem cell engineering and the bladder. Reporters had a unique opportunity to speak one on one with these cutting edge researchers. Dr Atala has been involved in stem cell tissue engineering for over 15 years in a huge multi-disciplinary team comprising some 200 researchers. He explained that the researchers have had many ups and downs along the way so far in this highly complex research. And it still has a very long way to go.
The basic principle in many forms of tissue engineering is to use a patient’s own cells to create new tissue since this will avoid many of the complications currently experienced with either donor tissue or - in the case of the bladder augmentation - with using segments of the patient’s own intestines. A vital aspect of tissue engineering is that engineered cells should not carry disease.
Dr Atala explained that in the case of the bladder the major hurdle was getting cells to grow outside the bladder. The cases reported in the Lancet which hit the headlines so sensationally concerned cystoplasty for young patients aged 4-19 years with neurogenic bladder due to spina bifida (high pressure or poorly compliant bladders). A bladder biopsy was obtained from each patient. Urothelial and muscle cells were grown in culture and seeded on a biodegradable scaffold. According to Dr Atala, the type of scaffolding is vital for each type of tissue replacement and the scaffold degrading time is crucial. A vast amount of research has already gone into these aspects. Around seven weeks after the biopsy, the bladder sections could be used for implanting into these patients.  

Another decade before a whole bladder
Our first question was of course when could they make an entire new bladder? This is in fact already being done experimentally in animals, we were told. But Dr Atala wished to emphasize that, even if these animal experiments prove successful, it could be at least another decade before a whole bladder could be implanted in human patients. Would this be a functioning bladder? In theory there is no reason why not. The engineered tissue contains its own nerves, muscles and blood vessels. This began to sound like something out of science fiction to us and I was having visions of ordering all kinds of replacements for parts of my body that are showing definite signs of wear and tear! This may indeed be possible one day, but alas not yet! All the doctors underlined that this cutting edge research goes slowly step by step. Progress is slow, many problems are encountered on the way and it is going to take many years before some of these problems are solved.

Our next question: when can this tissue engineering be used for PBS/IC patients? This was where PBS/IC expert Dr Michael Chancellor took over: there are no plans at the present to use PBS/IC patients in the experimental studies. “This is because painful bladder syndrome/interstitial cystitis has so many unknown factors and nobody yet understands the pain mechanisms. You can’t carry out this kind of experimental treatment, which is still in its early stages, with all those unknown factors”.

Dr Atala formed part of a team presenting a study on in vivo engineering of tissues using parthenogenesis-derived stem cells for urologic construction (AUA abstract 603). The researchers concluded that parthogenesis-derived cells may be an excellent cell source for therapeutic applications in patients requiring urologic reconstruction.
Dr Hannes Strasser from Austria participated in an investigational study to treat 111 patients suffering from stress urinary incontinence (SUI) to determine whether SUI could be effectively treated with muscle-derived stem cells (taken from the patient’s upper arm under anaesthesia), injected into the rhabdosphincter (AUA abstract 328). The aim of this was to reconstruct the sphincter muscle.
Dr. Larissa Rodriguez is conducting pioneering work in stem cell and tissue engineering research. Her current study in the use of adipose derived stem cells for tissue engineering of the lower urinary tract involves the use of stem cells to form specific tissues and organs. “In the near future, we hope to be able to use a patient's own stem cells to reconstruct the dysfunctional urethra to correct incontinence, as well as reinforce the weakening of tissues that results in vaginal prolapse in women”.
Michael Chancellor MD has been part of a Canadian/USA team investigating muscle-derived cells (MDC) injection technique to optimize the treatment of stress urinary incontinence (AUA abstract 1185). Although it’s still early days, a simple injection of MDC appears to improve stress urinary incontinence.

Although still in its early stages, stem cell engineering offers very exciting possibilities for the future in the field of incontinence if not yet for PBS/IC patients.

 
COURSE ON STEM CELL ENGINEERING


Photo: Dolores Lamb and Anthony Atala

Anthony Atala MD and Dolores Lamb PhD together presented a course on Tissue Engineering and Stem Cells in Urology (Course 46 IC) which held the audience totally spellbound from beginning to end.
Take home message from Dolores Lamb: “Stem cell studies hold great promise for understanding the basis and defining new treatments for a variety of diseases”.
Conclusions from Anthony Atala: “In regenerative medicine, efforts are currently underway to develop virtually every type of tissue and organ within the human body …. Various tissues are at different stages of development, with some already being used clinically, a few in preclinical trials, and some at the discovery stage. Progress suggests that engineered tissues may be a viable therapeutic option for those who require tissue replacement or repair”.
 
 
 
AUA ABSTRACTS: Below is a review of a small selection of the many abstracts related to PBS/IC presented at the AUA 2006 in Atlanta.
 

277. EFFECTS OF INTERLEUKIN 8 EXPRESSION ON UROTHELIAL HOMEOSTASIS.
Stephanie Tseng-Rogenski, Monica Liebert, Ann Arbor, MI.
Interleukin 8 (IL8) is a cytokine known to participate in tissue defences against infections through its chemotactic effect on white cells. However, data from an earlier study showed that IL8 mRNA (= messenger RNA) was down-regulated in bladder biopsies from patients with IC compared to normal controls. The researchers therefore decided to explore the function of IL8 in cultured normal human urothelial cells. The research team reached the conclusion that IL8 may play a role in the cellular maintenance of normal urothelial cells beyond the role of IL8 in the immune defence. Loss of IL8 expression in interstitial cystitis not only reflects altered urothelial differentiation but may contribute to poor urothelial survival in these patients. We look forward to hearing more in the future from these continuing studies.

 

278. SAFETY AND EFFICACY OF HYPERBARIC OXYGEN THERAPY FOR THE TREATMENT OF INTERSTITIAL CYSTITIS: A RANDOMIZED, SHAM-CONTROLLED, DOUBLE-BLIND TRIAL.
Arndt van Ophoven, Gordon Rossbach, Lothar Hertle, Muenster, Germany
This study was also presented at the AUA Press Briefing on PBS/IC.
The fact that hyperbaric oxygenation treatment has produced encouraging results with radiation cystitis patients, leading to reduction in pelvic pain, irritative symptoms and gross haematuria led to interest in this therapy as a possible method of treating PBS/IC patients.
Following the results of their prospective pilot study into hyperbaric oxygenation for the treatment of PBS/IC published in 2004, this group of researchers from Muenster, Germany has now carried out a further study into the safety, efficacy and feasibility of this treatment, where the patient is enclosed in a pressure chamber breathing oxygen at pressure greater than one atmosphere. Although conducted with a small population of 21 patients, the results of this study indicate that HBO is safe and produces a decrease in PBS/IC symptoms in patients. The therapy was carried out in daily sessions of 90 minutes, 6 days a week, for a total of 30 sessions. According to Dr A. van Ophoven, the current cost of a complete treatment of 30 sessions is € 3000 (approx $3820). Dr A. van Ophoven explained that you usually know within a week whether the treatment is likely to achieve an improvement. In this study, 2 patients from the active treatment group dropped out. After 1 year, 5 of the 12 PBS/IC patients still reported benefit. The sham treatment showed no benefits. HBO therapy seems to be most successful in reducing pain and urgency. It looks promising for some PBS/IC patients, but bearing in mind the need for daily treatment, feasibility would depend on HBO therapy centres being readily available and accessible. Plus – once again – the usual problem in the PBS/IC treatment world as to whether health insurance companies would refund the treatment.

Dr Van Ophoven’s take home messages were:
- 30 treatment sessions of HBO appear to be a safe, efficacious and feasible therapeutic approach to IC.
- In the treatment responders, application of HBO resulted in a sustained decrease of IC symptoms compared with a normobaric, normoxic sham treatment.
- The clinical characterization and identification of responders prior to start of treatment remain difficult.

 
279. BOTULINUM TOXIN TYPE A INHIBITS SUBSTANCE P RELEASE IN INFLAMMATORY RAT BLADDER MODEL.
Alvaro Lucioni, Gregory T. Bales, Katherine W. Turk, Tamara Lotan, Sean P. Cook, David E. Rapp, Chicago IL.
Increasing evidence suggests that neurogenic inflammation originating from afferent bladder neurons may play a role in urinary tract disorders such as interstitial cystitis. The aim of this animal study was to determine the effect of botulinum toxin A (BTX-A) on the release of the nociceptive neurotransmitter, Substance P, in a bladder model of chronic inflammation. The researchers hypothesized that administration of BTX-A would suppress release of Substance P. The results of this study led the researchers to conclude that use of BTX-A inhibits release of Substance P from the ends of nerves in the inflamed bladder of a rat. This suggests a potentially clinical benefit of the use of BTX-A when treating neurogenic inflammation that may underlie bladder disorders such as PBS/IC.
 
281. INSTILLATION OF LIPOSOMES IS SUPERIOR TO DMSO OR PENTOSAN POLYSULFATE IN REDUCING BLADDER HYPERACTIVITY.
Vincent Hsieh, Ratna Ganabathi, Naoki Yoshimura, Jonathan Kaufman, Michael B. Chancellor, Pradeep Tyagi, Pittsburgh PA.
The purpose of this study was to compare the effect of intravesical liposomes (LPs), DMSO and PPS on a model of chemically-induced overactive bladder in the rat. Result: While DMSO did not show any beneficial effect on induced bladder hyperactivity, both PPS and liposome did show benefit, with the intravesical liposome showing nearly double the intercontraction interval of PPS. The authors consider that intravesical liposome may be considered a new therapy for PBS/IC.
NB: Liposomes (LPs) are microscopic artificial vesicles composed of concentric phospholipid bilayers separated by aqueous compartments. Because LPs adsorb to cell surfaces and fuse with cells, they are being used as vehicles for drug delivery and gene therapy. In addition, they create a molecular film on cell surfaces and therefore are being tested as possible therapeutic agents to promote wound healing.
 
282. EFFECT OF IP-751, AJULEMIC ACID, AGAINST ACETIC ACID INDUCED BLADDER PAIN RESPONSES IN RATS 24H AFTER INTRAVESICAL ADMINISTRATION.
Ratna Ganabathi, Pradeep Tyagi, Fernando de Miguel, Shachi Tyagi, Naoki Yoshimura, Michael B. Chancellor, Pittsburgh PA.
Ajulemic acid (IP-751) is a potent analog of tetrahydrocannabinol (THC)-11-oic acid, a major metabolite of THC, the principal psychoactive component of cannabis. IP-751 is believed to be a non-psychoactive synthetic cannabinoid that produces analgesia without a “high”. In this study the researchers evaluated the effect of a cannabinoid agonist following intravesical administration. They concluded that when IP-751 is formulated with liposomes, it can suppress bladder nociceptive responses caused by bladder irritation. Therefore, intravesical liposomal formulation of ajulemic acid may be a promising treatment in patients with PBS/IC.
 
288. ANTI-TNF THERAPY PRESERVES BLADDER BARRIER FUNCTION IN A MOUSE MODEL OF NEUROGENIC CYSTITIS.
Michael C. Chen, David J. Klumpp, Chicago, IL.
TNF = Tumour Necrosis Factor, a molecule responsible for increasing levels of inflammation.
Interstitial cystitis is often regarded as a neurogenic cystitis. This mouse study was based on the hypothesis that mast cells play a role in the pathogenesis of IC, and mast cells are redistributed in the bladders of ulcerative IC patients. Results from the study indicated that anti-TNF therapy stabilizes trans-epithelial resistance. The authors concluded that anti-TNF therapy abrogates mast cell trafficking to the lamina propria and preserves bladder barrier function during neurogenic cystitis.
 
291. SEXUAL FUNCTIONING AS A DETERMINANT OF POOR QUALITY OF LIFE IN INTERSTITIAL CYSTITIS.
J. Curtis Nickel, Dean A. Tripp, Kingston ON Canada; Mary pat Fitzgerald, Maywood, IL; Valerie Teal, Kathleen J. Propert, the Interstitial Cystitis Clinical Trials Groups (ICCTG), Philadelphia, PA.
PBS/IC has a significant impact on a patient’s quality of life. This study examined the interrelationship of PBS/IC symptoms and associated bother, employment and sexual function on quality of life in a sample of patients with moderate to severe IC of long duration. This study identified sexual functioning as a strong predictor of both mental and physical quality of life. The nature of these relationships remains unstudied. Sexual functioning, employment and pain issues may be therapeutic targets in a multifaceted approach to treatment of IC patients.
 
292. EFFECTS OF COMESTIBLES ON SYMPTOMS OF INTERSTITIAL CYSTITIS
Barbara Shorter, Brookville, NY; Leslie Kushner, Robert M. Moldwin, New Hyde Park, NY.
While there has been little scientific research into the effect of foods and beverages on PBS/IC, anecdotal evidence has long supported the notion that certain foods and beverages can exacerbate symptoms of PBS/IC. Nutrition-based studies are particularly difficult to carry out since there are so many variables.
This study was therefore based on a questionnaire distributed to a group of patients diagnosed on the basis of NIDDK criteria. The aim was to see whether certain foods, beverages and/or dietary supplements affected symptoms of IC either positively or negatively. 154 comestibles were studied. Symptoms were exacerbated in 73% of patients, 5% indicated no exacerbation, while 22% didn’t know. 18% of the patients experienced a reduction in symptoms following consumption of certain items. It was concluded that there is a large number of PBS/IC patients whose symptoms are exacerbated by consumption of specific foods and beverages. The study identified the most bothersome foods: items containing caffeine, citrus fruits and juices, tomatoes and tomato products, items containing vinegar and alcoholic beverages. Coffee was the most bothersome.
 
294. QUANTITATIVE FLUORESCEIN UPTAKE FOR EVALUATION OF INTERSTITIAL CYSTITIS PERMEABILITY.
Robert D. Mayer, Ronald W. Wood, Rochester, NY.
This study with 12 IC patients and 11 controls was based on the hypothesis that an abnormality of urothelial permeability allows substances in the urine to cause local irritation, thereby causing interstitial cystitis. The purpose of the study was to evaluate Quantitative Fluorescein Uptake from the bladder as a diagnostic parameter of abnormal permeability barrier function in interstitial cystitis. The findings were rather unexpected, although this could have something to do with the low number of participating patients. IC patients appeared to have less maximal uptake than control patients. Although other factors could have played a role (IC patient’s age, prior treatment and long duration of symptoms), the results did not suggest that enhanced urothelial permeability is responsible for persistent symptoms in chronic IC patients.
 
295. LONG-TERM EFFICACY OF SACRAL NEUROMODULATION (INTERSTIM) IN PATIENTS WITH REFRACTORY INTERSTITIAL CYSTITIS (IC) SHOWS TENDENCY TO DECREASE.
Jurjen J. Bade, Adriaan J. Smans, Oss, The Netherlands.
This Dutch hospital has been using sacral neuromodulation since the end of 2001 as a third line treatment for intractable IC patients. This study investigated the long-term efficacy of permanent sacral neuromodulation (Interstim). After 3 months 85% (18 of 21) of the patients reported an improvement of 50% or more. After 25 months, this was reduced to 45%.
 
296.WOMEN WITH INTERSTITIAL CYSTITIS HAVE SIGNIFICANTLY MORE PELVIC SURGERIES THAN CONTROLS.
Kenneth M. Peters, Donna J. Carrico, Ibrahim A. Ibrahim, Kim A. Killinger, Maria Victoria C. Estanol, Royal oak , MI, Alessandra Graziottin, Milan, Italy, Ananias C. Diokno, Royal Oak, MI.
This mailed survey incorporated a urinary symptoms module along with information about pelvic surgery and hysterectomy. It was sent to 407 established IC patients and 5000 age-matched controls in the United States. Response rates were 53% IC patients (N=215) and 16% controls (N=823). The objective was to determine the prevalence of hysterectomies and pelvic surgeries in women with interstitial cystitis versus a community-based control group of women. Of the women with IC who had hysterectomies, 68% of the hysterectomies were done prior to their diagnosis of IC, 11% were done in the same year as their diagnosis of IC and 21% after their diagnosis of IC. The diagnosis of IC was made 1-5 years following hysterectomy in the majority of cases.
The researchers concluded that women with IC undergo significantly more pelvic surgery than women without IC. Most of this surgery is done prior to their diagnosis of IC. There is a need for clinical studies to evaluate if these surgeries were done for pain that may have been related to IC. One of the questions raised in this study was could pelvic surgeries have a negative effect on the innervation, pelvic musculature, mast cells or blood flow supporting the bladder. And could this actually trigger the painful bladder syndrome.
 
903. INTERSTITIAL CYSTITIS PAIN MARKEDLY LIMITS SEXUAL FUNCTIONING.
Kathryn J. Azevedo, Annie Nguyen, Ali Rowhani-Rahbar, Amy Rose, Erenee Sirinian, Anusha Valluru, , Christopher K. Payne, Stanford CA.
In order to obtain better insight into the psychosexual impact of interstitial cystitis on patients, a medical anthropologist collaborated with a team of clinicians. The study revealed that IC pain impacts the sexual functioning of men and women differently, with men specifically reporting IC pain-related difficulties in arousal, erection and ejaculation. Women IC patients not only experienced pain during intercourse, but also severe and debilitating increases in IC symptoms lasting several days following sexual intercourse. The researchers found that patients directly link IC pain to diminished sexual functioning, they are deeply concerned about their sexual functioning but are reluctant to discuss the problem with their doctor.
 

1176. EFFECT OF ST. JOHN’S WORT FORMULATION DP015 AGAINST ACETIC ACID INDUCED BLADDER PAIN IN RATS.
Ratna Ganabathi, Pradeep Tyagi, Jonathan Kaufman, Fernando De Miguel, Naoki Yoshimura, Michael B. Chancellor, Pittsburgh PA
St. John’s Wort (SJW) or Hypericum perforatum, named for John the Baptist, has many constituents (Naphthodianthrones, Hypericin, Pseudohypericin, Flavinoids, Xanthones), but its biological activity comes from Hyperforin. It was first used by the ancient Greeks as a medicinal plant as described by Hippocrates (460-377 BC) for:

  1. External use: myalgia, first degree burns
  2. Internal: neuralgia, anxiety, insomnia, depression.

SJW is popular in Germany, United States and Australia as a mild antidepressant. It has very little efficacy in severe depression. Side effects are generally mild but include gastrointestinal symptoms, dry mouth, allergic reactions, fatigue, confusion, dizziness, constipation and rarely photosensitization. The researchers will be looking further into drug interactions which are known to include SSRIs (serotonin syndrome), P450 enzyme induction (CYP3A4), oral contraceptives (particularly important for women), Cyclosporine, Theophylline, Digoxin, Warfin, anticonvulsants, triptans, HIV treatment (protease inhibitors).
The objective of this study was to examine the effect of SJW extract (DP015) on lower urinary tract function of rats under a “normal” non-irritated condition and in an irritated condition (ascetic acid infusion). The researchers concluded that acute administration of DP015 suppresses nociceptive responses induced by bladder irritation. The results support the use of DP015 as a supplement in patients with IC and other types of visceral pain. Future studies are proposed to escalate the dose of DP015 to develop a dose response curve and check its toxicity, to check the therapeutic effect of DP015 in already irritated bladder conditions and to carry out clinical studies on the effect of DP015 in patients with IC.

 
1300. SUPRATAST TOSILATE SUPPRESSES URINARY FREQUENCY THROUGH SUPPRESSION OF AFFERENT HYPERACTIVITY IN CHRONIC CYSTITIS RATS.
Yukio Hayashi, Pittsburgh, PA; Tsukasa Kirimoto, Koushi Nakano, Toshinori Oka, Mamoru Kinawa, Tokushima, Japan; Michael B. Chancellor, William C. de Groat, Naoki Yoshimura, Pittsburgh, PA
Supratast tosilate (IPD) as been shown to improve the symptoms of IC patients and also bladder dysfunction in rats with chemically induced chronic cystitis. However the mechanism for this improvement is not yet fully understood. This study therefore examined how IPD can improve the functional properties of bladder afferent pathways in chronic cystitis rats. The study findings indicate that hyperexcitability of bladder afferent pathways contributes to urinary frequency induced by chronic cystitis and that IPD could suppress afferent hyperexcitability to improve bladder dysfunction in chronic bladder inflammation at least in part via activation of KA channels. The authors conclude that these mechanisms might be involved in the therapeutic effects of IPD in IC patients.
 
VIDEO 1669

A CYSTOSCOPIC ATLAS OF INTERSTITIAL CYSTITIS AND BLADDER ULCERS
John C. Craft, Christopher K. Payne, Stanford CA.
This 9 minute video presented by Christopher Payne MD included hydrodistension and glomerulations; Hunner’s ulcers (lesions) and treatment of these. It represents a valuable means for the urologic community and others to learn about this problem and how to perform the procedure correctly.
This video is obtainable from the AUA on a set of 2 DVDs. This set is 2006 Digital Video Sessions – Session 8: Female Urology, Incontinence, 06DVDSES8, price $ 40. See www.auanet.org/products.

 
COURSE 70 EC PAINFUL BLADDER SYNDROME/INTERSTITIAL CYSTITIS:
Philip Hanno MD, David Burks MD
 

This well-attended course incorporated a number of valuable interactive elements which underlined the fact that many urologists from all over the world have a lot of questions that need answering. The course covered current international dialogue, definitions, pathogenesis, potential therapeutic targets, epidemiology, pathology, antiproliferative factor, treatment, diagnosis, management algorithms and case studies.

 

Photo: Philip Hanno MD
 

COURSE 109 EC TREATMENT OF FEMALE OAB AND PAINFUL BLADDER SYNDROME:
Christopher Payne MD, Deborah Erickson MD, Kenneth Peters MD

An excellent practical, down-to-earth, up-to-date course with a very well-designed handout which I am sure all participants will find very useful.

The handouts of both of the above courses can be found on the AUA CD-ROM with Instructional and Postgraduate MC, EC and DL Courses. This also includes the handout from the Tissue Engineering course.

 
WEBCASTS

Official webcasts of many plenary sessions at the AUA meeting can be found on

www.aua2006.org/webcasts or

http://webcasts.prous.com/aua2006/officials.asp?CID=YY&CLID=2

See for example:
- State-of-the-art: New Developments in Prostatitis by J Curtis Nickel MD.
- Highlights from 20/21 May: Infection/Inflammation, Female Urology/Incontinence
- AUA Updates: Stress Urinary Incontinence Guidelines
- Take Home Messages: Female Urology/Incontinence
And many more fascinating presentations by top speakers in all fields of urology.

 
REFERENCES

Henry R, Patterson L, Avery N, Tanzola R, Tod D, Hunter D, Nickel JC, Morales A. Absorption of alkalized intravesical lidocaine in normal and inflamed bladders: a simple method for improving bladder anesthesia. J Urol. 2001 Jun;165(6 Pt 1):1900-3.

Jabbari B, Maher N, Difazio MP. Botulinum Toxin A improved burning pain and allodynia in two patients with spinal cord pathology. Pain Med. 2003 Jun;4(2):206-10.

Smith CP, Radziszewski P, Borkowski A, Somogyi GT, Boone TB, Chancellor MB. Botulinum Toxin A has antinociceptive effects in treating interstitial cystitis. Urology. 2004 Nov;64(5):871-5;discussion 875.

Atala A, Bauer SB, Soker S, Yoo JJ, Retik AB. Tissue-engineered autologous bladders for patients needing cystoplasty. Lancet.2006 Apr 15;367(9518):1215-6.

 
Jane Meijlink

 

 
The International Painful Bladder Foundation (IPBF) does not engage in the practice of medicine. It is not a medical authority nor does it claim to have medical knowledge. The IPBF advises patients to consult their own physician before undergoing any course of treatment or medication.
updated 29.05.2007 14:02 © 2006-2018 International Painful Bladder Foundation (IPBF). All rights reserved.