icnmgrjill
07-11-2008, 02:22 PM
Established a few years ago, the European Society For the Study of IC has become a “think tank” for researchers and clinicians in Europe who are passionate about studying IC/PBS/BPS. The ESSIC society was the group that proposed changing the name interstitial cystitis to bladder pain syndrome, which they have done now in Europe. They also proposed sweeping changes in the way IC/PBS/BPS should be diagnosed which we have discussed, in depth, in previous e-newsletters. At this years meeting, more than 100 professionals gathered in Rome to discuss theories, treatments and research studies. Here are some highlights:
Antecedent non-bladder syndromes in a case control study of interstitial cystitis/painful bladder syndrome
Jack Warren (Univ. of Md, USA) and colleagues have released the results of a study which will have some IC patients saying “I thought so.” Their goal was to determine if IC occurred after patients developed other similar syndromes. Their study determined that 78% of participating IC patients were identified as having multiple syndromes, particularly fibromyalgia, chronic fatigue syndrome, sicca syndrome and IBS. Migraines, chronic pelvic pain, depression and allergy were also related, though to a lesser degree. They found that a total of eleven syndromes were more often diagnosed in IC/PBS patients and that most syndromes appeared in clusters (i.e. that patients struggled with more than just one condition at a time). These results support the theory that, for some patients, IC may be part of a systemic (body wide) syndrome as opposed to just affecting the bladder.
Preliminary data concerning pain and quality of life in patients with BPS/IC
Researchers J. Nordling and B. Richter (Herlev Univ. Hospital, Denmark) studied 153 IC patients over a 40 year period (1967-2007) to review the longitudinal course of the disease. The results are encouraging because the vast majority of patients (52%) felt that their condition and quality of life had improved over time, though 17% felt unchanged and 19% felt worse. The researchers concluded that pain intensity seemed to weaken through the course f the disease. They also studied the effect of several treatments but lacked enough data to make strong conclusions. However, they did see tendencies with instillations of DMSO, Cystistat, and oral treatment with amitriptylin, pregabalin, Singulair, antihistamines and steroids that appeared to improve improved disease condition in a third to a half of treated persons.
Bladder Pain Syndrome/Interstitial Cystitis and Vulvodynia: two aspects of one syndrome
Mauro Cervigni and colleagues at S. Carlo-IDI Hospital (Rome, Italy) found a strong correlation between IC and vulvodynia in a study of 49 sexually active women diagnosed with IC. These women experienced typical vulvodynia symptoms including painful intercourse (dyspareunia), itching and vulvar burning. After being treated for PBS/IC, 30.6% had a complete relief of their painful intercourse symptoms and 42.9% had improvement. Sadly, 26.5% of patients, who despite an improvement of their symptoms, refused to have sexual intercourse out of fear of a worsening of their symptoms. The researchers stated “Our data suggest a real association of vulvodynia with BPS/IC. The coexistence of symptoms in the bladder and symptoms in the vulvar region suggests a possible relationship and could indicate the presence of one pelvic inflammation affecting various organs in this area.” How they are related, however, is still speculative. It may be the result of neuroinflammation.
Statistical analysis of symptoms, endoscopy and urothelial morphology in fifty-eight bladder pain syndrome/interstitial cystitis female patients
Researchers in the Czech republic sought to determine if oral or intravesical therapies were the most successful, in the long term, in improving bladder condition. They studied 31 patients who had used oral medications and 27 patients who received heparin instillations. Each underwent thorough bladder examinations the results of which confirmed that both treatments appeared to improve the bladder (i.e. bladder capacity, mast cell counts) but that intravesical therapy (i.e. heparin treatments) was more effective than oral therapies in reducing the number of mast cells in bladder biopsy samples. Age, disease duration, and time to diagnosis did not reflect treatment outcome. Symptom severity did seem to higher in older patients.
CISTIC STUDY REPORT. Prospective double-blind randomized controlled multi-center study investigating the efficacy of hyaluronan in BPS/IC
Claus Riedl (Austria) presented the results of a four year, international study which sought to determine the effectiveness of eight weekly hyaluronan (aka Cystistat) instillation treatments. The results were startling and controversial. They noted an overall improvement in 60% of patients treated with hyaluronan, a response rate higher than any other published study. However, a whopping 80% improvement was found in the control group. Why did the control group have such a positive response? They appeared to be taking far more medications than the active group and had suffered with IC symptoms for less time than the active group. If anything, this study demonstrates just how difficult it is to design a study for IC.
Urodynamics and Interstitial Cystitis/Painful Bladder Syndrome
Urodynamics is a test most IC patients should be familiar with. It studies our bladder function and is helpful in making a diagnosis of overactive bladder. But, it hasn’t been particularly useful in studying IC until today. Kristene Whitmore (USA) did a retrospective study of urodynamic data of her IC patients and found some strong, useful correlations in first sensation, first urge, strong desire to urinate and particularly with patients who volunteered that their bladders hurt as it was being filled. She strongly urged urologists to assess pain on bladder filling.
Evaluation of the efficacy of intravesical chondroitin sulphate in BPS/IC
The competition for marketshare between intravesical chondroitin and intravesical hyaluronan has raged for years in Europe. Dr. Arunkalaivanan and colleagues (Birmingham UK) UK studied the effects of 2% chondroitin sulphate given intravesically for BPS/IC weekly for one month, then twice a month and finally once a month if there was an initial response. The results showed no significant improvement.
Antecedent non-bladder syndromes in a case control study of interstitial cystitis/painful bladder syndrome
Jack Warren (Univ. of Md, USA) and colleagues have released the results of a study which will have some IC patients saying “I thought so.” Their goal was to determine if IC occurred after patients developed other similar syndromes. Their study determined that 78% of participating IC patients were identified as having multiple syndromes, particularly fibromyalgia, chronic fatigue syndrome, sicca syndrome and IBS. Migraines, chronic pelvic pain, depression and allergy were also related, though to a lesser degree. They found that a total of eleven syndromes were more often diagnosed in IC/PBS patients and that most syndromes appeared in clusters (i.e. that patients struggled with more than just one condition at a time). These results support the theory that, for some patients, IC may be part of a systemic (body wide) syndrome as opposed to just affecting the bladder.
Preliminary data concerning pain and quality of life in patients with BPS/IC
Researchers J. Nordling and B. Richter (Herlev Univ. Hospital, Denmark) studied 153 IC patients over a 40 year period (1967-2007) to review the longitudinal course of the disease. The results are encouraging because the vast majority of patients (52%) felt that their condition and quality of life had improved over time, though 17% felt unchanged and 19% felt worse. The researchers concluded that pain intensity seemed to weaken through the course f the disease. They also studied the effect of several treatments but lacked enough data to make strong conclusions. However, they did see tendencies with instillations of DMSO, Cystistat, and oral treatment with amitriptylin, pregabalin, Singulair, antihistamines and steroids that appeared to improve improved disease condition in a third to a half of treated persons.
Bladder Pain Syndrome/Interstitial Cystitis and Vulvodynia: two aspects of one syndrome
Mauro Cervigni and colleagues at S. Carlo-IDI Hospital (Rome, Italy) found a strong correlation between IC and vulvodynia in a study of 49 sexually active women diagnosed with IC. These women experienced typical vulvodynia symptoms including painful intercourse (dyspareunia), itching and vulvar burning. After being treated for PBS/IC, 30.6% had a complete relief of their painful intercourse symptoms and 42.9% had improvement. Sadly, 26.5% of patients, who despite an improvement of their symptoms, refused to have sexual intercourse out of fear of a worsening of their symptoms. The researchers stated “Our data suggest a real association of vulvodynia with BPS/IC. The coexistence of symptoms in the bladder and symptoms in the vulvar region suggests a possible relationship and could indicate the presence of one pelvic inflammation affecting various organs in this area.” How they are related, however, is still speculative. It may be the result of neuroinflammation.
Statistical analysis of symptoms, endoscopy and urothelial morphology in fifty-eight bladder pain syndrome/interstitial cystitis female patients
Researchers in the Czech republic sought to determine if oral or intravesical therapies were the most successful, in the long term, in improving bladder condition. They studied 31 patients who had used oral medications and 27 patients who received heparin instillations. Each underwent thorough bladder examinations the results of which confirmed that both treatments appeared to improve the bladder (i.e. bladder capacity, mast cell counts) but that intravesical therapy (i.e. heparin treatments) was more effective than oral therapies in reducing the number of mast cells in bladder biopsy samples. Age, disease duration, and time to diagnosis did not reflect treatment outcome. Symptom severity did seem to higher in older patients.
CISTIC STUDY REPORT. Prospective double-blind randomized controlled multi-center study investigating the efficacy of hyaluronan in BPS/IC
Claus Riedl (Austria) presented the results of a four year, international study which sought to determine the effectiveness of eight weekly hyaluronan (aka Cystistat) instillation treatments. The results were startling and controversial. They noted an overall improvement in 60% of patients treated with hyaluronan, a response rate higher than any other published study. However, a whopping 80% improvement was found in the control group. Why did the control group have such a positive response? They appeared to be taking far more medications than the active group and had suffered with IC symptoms for less time than the active group. If anything, this study demonstrates just how difficult it is to design a study for IC.
Urodynamics and Interstitial Cystitis/Painful Bladder Syndrome
Urodynamics is a test most IC patients should be familiar with. It studies our bladder function and is helpful in making a diagnosis of overactive bladder. But, it hasn’t been particularly useful in studying IC until today. Kristene Whitmore (USA) did a retrospective study of urodynamic data of her IC patients and found some strong, useful correlations in first sensation, first urge, strong desire to urinate and particularly with patients who volunteered that their bladders hurt as it was being filled. She strongly urged urologists to assess pain on bladder filling.
Evaluation of the efficacy of intravesical chondroitin sulphate in BPS/IC
The competition for marketshare between intravesical chondroitin and intravesical hyaluronan has raged for years in Europe. Dr. Arunkalaivanan and colleagues (Birmingham UK) UK studied the effects of 2% chondroitin sulphate given intravesically for BPS/IC weekly for one month, then twice a month and finally once a month if there was an initial response. The results showed no significant improvement.