Prevalence and psychosocial correlates of symptoms suggestive of painful bladder syndrome: results from the Boston Area Community Health Survey. Link CL, Pulliam SJ, Hanno PM, et al. J Urol. 2008 Jun 11. [Epub ahead of print] •the overall prevalence of symptoms suggestive of painful bladder syndrome was 2% (1.3% in men and 2.6% in women) with increased prevalence in middle-aged adults and those of lower socioeconomic status • symptoms suggestive of painful bladder syndrome were more common in those who experienced abuse, in those who were worried about someone close to them and in those who were having trouble paying for basics; this pattern held even after adjusting for depression. • the authors conclude that painful bladder syndrome is associated with a number of lifestyle and psychosocial correlates, suggesting that the treatment may benefit from a multifaceted approach of combining medical, psychological and cognitive treatment.
resiniferatoxin
Resiniferatoxin in the treatment of interstitial cystitis: a systematic review. Mourtzoukou EG, Iavazzo C, Falagas ME. Int Urogynecol J Pelvic Floor Dysfunct 2008 Jun 19 [Epub ahead of print]
• in this review from Greece, the authors conclude that the effectiveness of resiniferatoxin in the treatment of interstitial cystitis remains unknown; six studies produced contradictory results
Urinary tract infection and inflammation at onset of interstitial cystitis/painful bladder syndrome. Warren JW, Brown V, Jacobs S, et al. Urology 2008;71:1085-90 • the retrospective data in this study suggest that a proportion, probably a minority, of women at IC/PBS onset had evidence of UTI or inflammation • the results indicate that UTI is present at the onset of IC/PBS in some women and might reveal clues to IC/PBS pathogenesis
review
What is new in bladder pain syndrome/interstitial cystitis? Hanno P, Nordling J, van Ophoven A. Curr Opin Urol 2008;18:353-8
• in this review the authors bring practicing healthcare providers up to date with the literature on bladder pain syndrome/interstitial cystitis, and the implications for their patients
Mast cell-derived histamine mediates cystitis pain.(click on the title for full article) Rudick CN, Bryce PJ, Guichelaar LA, et al. PLos ONE 2008 May 7;3(5):e2096
• data obtained from this study demonstrate that mast cells promote cystitis pain and bladder pathophysiology through the separable actions of histamine and tumor necrosis factor alpha (TNF), respectively
• the authors conclude that pain is independent of pathology and inflammation, and histamine receptors represent direct therapeutic targets for pain in IC and other chronic pain conditions
cyclosporine A
Cyclosporine A in the Treatment of Interstitial
Cystitis. Jukka Sairanen. Academic dissertation, University of Helsinki, Finland, 25 January 2008 • the author concludes that cyclosporin A is a viable treatment option in patients with PBS/IC who fulfil the
NIDDK criteria and have serious symptoms and in whom previous attempts to alleviate
symptoms have failed; the author also concludes that his results support the need for future clinical studies with drug
compounds that modulate inflammation in PBS/IC bladder.
depression and anxiety
Psychological profile of Taiwanese interstitial cystitis patients. Fan YH, Lin AT, Wu HM, et al. Int J Urol 2008;15:416-8 PMID: 18452458
• the researchers found that most of their Taiwanese patients had significant depression and anxiety and that the extent of the symptoms appeared to correlate with the severity of the IC symptoms
Treatment of Bladder Pain Syndrome/Interstitial Cystitis 2008: Can we make evidence-based decisions? Fall M, Oberpenning F, Peeker R. Eur Urol 2008 Apr 3 [Epub ahead of print] PMID: 18403099
• a review of treatment; controlled studies are scarce; much evidence is based on a trial and error principle and studies give conflicting results
• everyone has their own different perceptions as to what interstitial cystitis and painful bladder syndrome are and how they should be treated
• it is described by the authors as a poorly defined heterogeneous spectrum of disorders
• inclusion and exclusion criteria in studies form a significant problem; definitions are loose and differ from centre to centre and in different parts of the world
care
Characterization of a clinical cohort of 87 women with interstitial cystitis/painful bladder syndrome. Peters KM, Carrico DJ, Diokno AC. Urology 2008;71:634-40 • the described population of women with unrelieved chronic pain, frequency, and urgency is in desperate need of care.
• the authors conclude that it may be most therapeutic to develop a multimodal plan of care that includes physical therapy, oral and intravesical therapies, neuromodulation, and cognitive-behavioral therapies
pain
Evidence-based criteria for pain of
interstitial cystitis/painful bladder syndrome in women. Warren JW, Brown J, Tracy JK, et al. Urology 2008;71:444-8
• in this Events Preceding Interstitial Cystitis study, pain that worsened with a certain food or
drink and/or worsened with bladder filling and/or improved with urination was reported by 151(97%) of 156 patients; these were the only three criteria that applied directly to the bladder
• the same three criteria described the pain of 262 (97%) of 270 women in the Interstitial Cystitis
Database who “definitely” had IC/PBS • the authors conclude that this triad might
describe the pain of IC/PBS and contribute to a sensitive case definition
Longidaze in therapy of patients with interstitial cystitis[Article in Russian] Zaitcev AV, Pushkar DU. Urologiia 2007 Sept-Oct;(5):35-7 • a pilot study using the injected enzyme agent longidaze (conjugate of hyaluronidase with activated derivate of N-oxide poly-1,4-ethylenpiperazine) in a study group of 30 patients (including 7 Hunner's ulcer/lesion patients): 3000 IU, 10 injections, every 5 days
• the authors believe that the algorithm for Hunner's patients should include Holmium laser coagulation as a first step, followed by longidaze treatment
• in non-ulcerative patients the longidaze is added to multimodal treatment
• the aim of the therapy is to correct inflammatory disorders, prevent progressive fibrosis, and restore detrusor elasticity
• the results of this pilot study were positive and the study will be continued
botulinum A toxin
Botulinum A Toxin Intravesical Injection in Patients With Painful Bladder Syndrome: 1-Year Followup.
Giannantoni A, Porena M, Costantini E, et al. J Urol 2008 Jan 17 [Epub ahead of print]
• in this small study, intravesically injected botulinum toxin A appeared to be effective for short-term treatment of PBS that has failed to respond to other treatment
• this form of treatment needs to be repeated after a few months
RDP58 inhibits T cell-mediated bladder inflammation in an autoimmune cystitis model. Liu W, Deyoung BR, Chen X, et al. J Autoimmun. 2007 Dec 24 [Epub ahead of print]
• RDP58 is a novel d-amino acid decapeptide with potent immunosuppressive activity
• this study investigated whether it was effective as an intravesical agent for treating bladder autoimmune inflammation in mouse model
• collectively the results indicated that RDP58 is effective for treating T cell-mediated experimental autoimmune cystitis and may serve as a useful intravesical agent for the treatment of autoimmune-associated bladder inflammation such as IC.
hyaluronate
Hyaluronan treatment of interstitial cystitis/painful bladder syndrome. Riedl CR, Engelhardt PF, Daha KL, et al. Int Urogynecol J Pelvic Floor Dysfunct 2007 Dec 21 [Epub ahead of print] • this study evaluated the efficacy of intravesical hyaluronan therapy in 126 patients with IC/PBS and mean disease duration of 6.1 years; to be eligible for hyaluronan treatment, a positive modified potassium test was requested as a sign of a urine-tissue barrier disorder • patients were treated with weekly instillations of a 50 ml phosphate-buffered saline solution containing 40 mg sodium hyaluronate
• data were obtained by a visual analogue scale (VAS) questionnaire rating from 0 to 10 that asked for global bladder symptoms before and after therapy; additional questions evaluated the therapeutic impact on quality of life
• 85% of the patients reported symptom improvement (2 or more VAS units); the mean initial VAS score of 8.5 decreased to 3.5 after therapy (p<0.0001); 55% remained with no or minimal bladder symptoms after therapy (VAS 0-2); 84% reported significant improvement of their quality of life
• intravesical therapy had to be initiated again with good success in 43 patients (34.5%) as symptoms recurred after discontinuation of treatment, while the rest stayed free of symptoms for up to 5 years
• in general, hyaluronan therapy was well tolerated and, with the exception of mild irritative symptoms, no adverse reactions were reported for a total of 1,521 instillations
• the authors conclude that timely hyaluronan instillation therapy may lead to complete symptom remission or even cure in part of the IC/PBS patients, while some responders need continuous intravesical therapy
• the present results suggest that selection of patients for hyaluronan therapy by potassium testing improves the outcome of intravesical therapy with a response rate of >80%
Re-imagining Interstitial Cystitis. Hanno PM. Urol Clin North Am 2008;35:91-9 • a review of the history of changes and developments in IC and PBS down to the present day controversies
management review
Pharmacologic management of painful bladder syndrome/interstitial cystitis: a systematic review. Dimitrakov J, Kroenke K, Steer WD, et al. Arch Intern Med 2007;167:1922-9 • over 180 different therapies have been tried for PBS/IC, yet evidence from trials remains inconclusive
• this study concludes that PPS may be modestly beneficial for PBS/IC
• there is insufficient evidence for other pharmacologic treatment
• a consensus on standardized outcome measures is urgently needed