icnmgrjill
07-15-2008, 12:00 PM
AUA Round-up 2008
By Stacey Shannon
The American Urological Association held its annual scientific meeting from May 17 to 22 in Orlando, Fla. Urologists from around the globe convened on the city to discuss their latest research in urology, including IC. The debate over whether to change the name from IC to Painful Bladder Syndrome or Bladder Pain Syndrome continued, but other research was discussed more predominantly.
Why there are more female ICers
With estimates that 90 percent of IC patients are female, researchers continue to explore reasons why so many more women present with IC than their male counterparts.
A research team in Japan took on this topic in a study of male and female mice. They determined that females have more acid-sensing ion channels than males. As such, females are more sensitive to acetic acid and feel its effect on their bladders more than men. The study asserted that acid-sensing ion channels play a role in IC and should be looked at further for advancement in diagnostics and treatment.
Another research team, this one in Madison, Wis., tackled this topic by looking at estrogen receptors. They found that one specific type of estrogen receptor influences bladder function. In comparing male and female mice with the same sort of bladder issues, the female mice ranked much higher on the pain and frequency scales than their male counterparts. The researchers concluded that this one estrogen receptor impacts pain perception associated with IC symptoms. That’s not to say that men don’t have IC or suffer from its symptoms. This preliminary research may help explain the differences in how patients perceive pain associated with IC.
Sexual function varies based on pain location
Sexual functions are a challenge to many IC patients. Researchers out of Canada took a look into one part of this broad topic. They found that IC patients who had bladder sensitivity in only the neck of the bladder versus in multiple locations were able to regain more sexual function quicker during treatment than those with multiple pain locations. While the information is perhaps not earth-shattering, it is the kind of information that leads to the better treatment of IC patients as a whole.
Hydrodistension may not be the only option
Cystoscopy with hydrodistension has long been the preference of urologists in looking at bladders with IC. Patients have endured being anesthetized for such procedures for years. However, researchers in Japan and Pennsylvania have collaborated in a study to show that a flexible cystoscopy works just as well for diagnosing IC patients.
They said the flexible cystoscope, in conjunction with what is called a narrow band imaging system, allows them to see Hunner’s ulcers and other IC indicators just as easily as with a rigid cystoscope.
The good news for patients is that the flexible cystoscopy doesn’t require a hydrodistension and is a much less invasive diagnostic tool with fewer complications and repercussions.
“Since it does not require hydrodistension, IC diagnosis can be made simply, less invasively and at lower cost in outpatients,” the researchers said.
This new research is not widely accepted, yet, so patients shouldn’t be surprised if their local urologist isn’t utilizing the flexible cystscope, yet. With only 52 patients involved in this study, further research will most likely be conducted in a wider group to make sure this modified diagnostic tool is effective.
Lidocaine instills seem to help
For the last few years, urologists throughout the country have been using lidocaine instillations in their IC patients to help relieve symptoms. Two studies at AUA focused on how effective lidocaine is in treating IC symptoms.
Both studies found that by and far lidocaine at least improved the symptoms of the patients studied. The first study came from researchers in New Hyde Park, NY. They studied only eight patients between April and August 2007. Patients’ symptoms were assessed before starting the treatments. Each patient was then given lidocaine instillations to be held in the bladder for 10 minutes. Their symptoms were significantly improved after receiving the instillations.
“These changes were of greater magnitude than expected from previously published effects,” the researchers said. “No adverse events were reported.”
The second study came from researchers in Canada who looked at a specific type of aklaized lidocaine to determine whether it effectively treats IC symptoms. Researchers worked with 102 adult patients diagnosed with IC. Patients were given a daily instillation of lidocaine or a placebo for five consecutive days.
Three times as many patients receiving the lidocaine instillations reported their IC symptoms were moderately or markedly improved on day eight following the treatment. Most of those receiving lidocaine instillations elected to have a second course of treatment. More than half of those reported even greater improvement in their symptoms within one month from the beginning of the study.
The aklkalized lidocaine (PSD597), therefore, seems to be an effective treatment for IC symptoms according to this study. The researchers found that improvements in symptoms were maintained beyond the end of treatment.
Depression and sexual abuse rates are higher in IC patients
While no researcher at AUA asserted that IC is caused by depression or abuse, researchers from Philadelphia did find that the rates of depression and history of sexual abuse in IC patients is significantly higher than that of the general population. The results are a staggering and sobering look at the emotional impact IC has.
Researchers conducted an anonymous study between September 2006 and February 2007 of 141 women who had been diagnosed with IC for at least six months. With a median age of 46, the women completed a survey to identify depression.
Of the 141 patients, 97 (69 percent) had scores indicating depression. Only 9 percent of a comparable group in the general U.S. population is depressed. And of the IC patients who were depressed, a significant number fell into the category of moderate to severe depression.
The research also looked at history of sexual abuse. While 25 percent of the general population reports childhood sexual abuse, the number doubled to 51 percent when looking at the surveyed IC patients.
Researchers found that IC patients were comparable to the general population in a history of physical abuse and that fewer IC patients reported emotional abuse than the U.S. average.
The researchers concluded that since depression and history of sexual abuse are much higher in IC patients then urologists need to screen for these issues and refer patients to a qualified mental health expert for treatment.
Certain nerves seem to be responsible for bladder pain
As urologists begin to delve into research to determine whether IC is solely a bladder condition or whether it is more centralized in the nervous system, a study from researchers in Kyoto, Japan, has at least found that certain nerves seem to be more sensitive in IC and OAB patients.
The research team concluded that C fibers, which have receptors for temperature, body position and pain, are hypersensitive in severe IC and OAB patients. A-delta fibers, which are associated with cold and pressure, also seem to be hypersensitive in this same group.
Studies like these may give researchers insight into how to better treat IC in the future.
Distinguishing between IC and OAB
When symptoms overlap, distinguishing between two different conditions can be a challenge. Urgency is a symptom that both IC and OAB patients report. Urologists are continually looking for the best ways to discern what condition a patient has.
Researchers from Ann Arbor, Mich., and Santa Monica, Calif., conducted a 90-minute phone interview about urgency with 236 IC patients and 125 OAB patients. In comparing the responses from the two groups, more OAB patients reported leakage than IC patients and considered urgency more of a problem. Both patients reported that urgency can occur suddenly or gradually.
The main difference seemed to be that 87 percent of IC patients reported urgency due to pain, pressure or discomfort rather than fear of leakage like with the OAB patients. However, that cannot be the only distinguishing characteristic because approximately half of OAB patients reported urgency due to pain, pressure or discomfort. OAB patients did report more incidents of feeling a sudden sense of urgency with immediate leakage.
First long-term study of bladder removal in IC patients finds success stories
Researchers in Cleveland, Ohio, presented at study looking at the long-term outcome of bladder removal and substitution in patients with refractory IC. What they found is that quality of life tends to improve and stay improved in these patients.
The researchers looked at sexual function, pain relief, voiding symptoms, sleep and overall quality-of-life. The study was conducted with 15 women who had a median age of 37 and a median timeframe six years since their bladder removal. In the survey all the women reported better levels of sexual function and quality-of-life.
The women reported that their sexual function overall was twice as good as it had been before bladder removal. The majority (11 of 15) said they had a marked improvement in pain, voiding symptoms and nighttime sleep. Two reported a moderate improvement in those areas while another two reported a slight improvement.
Mast cells play a major role in IC
Three studies present at AUA reported findings on the relationship between mast cells and IC. The studies confirmed that mast cells most definitely play a role in IC.
The first study, which came from researchers in Chicago, found that mast cells in the bladder cause cystitis pain and bladder inflammation. Through using mice, the researchers found that though mast cells cause such symptoms, antihistamines decrease those symptoms. Thus confirming what patients and doctors have known for a few years in using medications like Vistaril to treat IC symptoms.
The second study came from researchers in Pittsburgh who found that mast cells don’t stay only in the bladder. Mast cells migrate between the colon and bladder, which causes irritation in both organs. This information helps explain why IC and IBS tend to go hand-in-hand for many patients. Both issues are caused by the same type of mast cells. Researchers found that once the colon was irritated, the bladder would be irritated and vice versa.
The last study dealing with mast cells came from researchers in Iowa City, Iowa. This study found that interrupting mast cell function alleviates bladder inflammation. Their conclusion was that targeting mast cells may be a useful approach to treating bladder inflammation causes by conditions such as IC in the future.
Botox may be beneficial in treating IC
Botulinum toxin A has been on urology radars in the last few years as a perhaps promising treatment for IC. Researchers working together from Pittsburgh and Taiwan presented two studies at AUA examining the effect of Botox on bladder inflammation and hyperactivity.
Both studies essentially concluded that Botox does suppress induced bladder inflammation and hyperactivity. One of the studies also concluded that while Botox did alleviate the aforementioned systems, it didn’t affect the spinal cord at all. Basically, Botox works well to treat just the bladder alone.
Gene therapy may be effective
Researchers from Pittsburgh presented a study looking a specific kind of gene therapy used to treat IC. Though it’s in the early stages, the research seems promising when conducted in rats.
Enkephalins are like endorphins in that they are produced during the body’s response to pain. Enkephalins block pain signals to the spinal cord while endorphins block pain at the brain stem. Both are morphine-like substances that function similar to opium-based drugs.
This study looked specifically at the impact of enkephalins and found that symptoms improved when rats with IC were given enkephalin gene therapy. The researchers concluded this may be a potential treatment for pain in IC patients and that the therapy does not have systemic side effects like many oral medications do.
By Stacey Shannon
The American Urological Association held its annual scientific meeting from May 17 to 22 in Orlando, Fla. Urologists from around the globe convened on the city to discuss their latest research in urology, including IC. The debate over whether to change the name from IC to Painful Bladder Syndrome or Bladder Pain Syndrome continued, but other research was discussed more predominantly.
Why there are more female ICers
With estimates that 90 percent of IC patients are female, researchers continue to explore reasons why so many more women present with IC than their male counterparts.
A research team in Japan took on this topic in a study of male and female mice. They determined that females have more acid-sensing ion channels than males. As such, females are more sensitive to acetic acid and feel its effect on their bladders more than men. The study asserted that acid-sensing ion channels play a role in IC and should be looked at further for advancement in diagnostics and treatment.
Another research team, this one in Madison, Wis., tackled this topic by looking at estrogen receptors. They found that one specific type of estrogen receptor influences bladder function. In comparing male and female mice with the same sort of bladder issues, the female mice ranked much higher on the pain and frequency scales than their male counterparts. The researchers concluded that this one estrogen receptor impacts pain perception associated with IC symptoms. That’s not to say that men don’t have IC or suffer from its symptoms. This preliminary research may help explain the differences in how patients perceive pain associated with IC.
Sexual function varies based on pain location
Sexual functions are a challenge to many IC patients. Researchers out of Canada took a look into one part of this broad topic. They found that IC patients who had bladder sensitivity in only the neck of the bladder versus in multiple locations were able to regain more sexual function quicker during treatment than those with multiple pain locations. While the information is perhaps not earth-shattering, it is the kind of information that leads to the better treatment of IC patients as a whole.
Hydrodistension may not be the only option
Cystoscopy with hydrodistension has long been the preference of urologists in looking at bladders with IC. Patients have endured being anesthetized for such procedures for years. However, researchers in Japan and Pennsylvania have collaborated in a study to show that a flexible cystoscopy works just as well for diagnosing IC patients.
They said the flexible cystoscope, in conjunction with what is called a narrow band imaging system, allows them to see Hunner’s ulcers and other IC indicators just as easily as with a rigid cystoscope.
The good news for patients is that the flexible cystoscopy doesn’t require a hydrodistension and is a much less invasive diagnostic tool with fewer complications and repercussions.
“Since it does not require hydrodistension, IC diagnosis can be made simply, less invasively and at lower cost in outpatients,” the researchers said.
This new research is not widely accepted, yet, so patients shouldn’t be surprised if their local urologist isn’t utilizing the flexible cystscope, yet. With only 52 patients involved in this study, further research will most likely be conducted in a wider group to make sure this modified diagnostic tool is effective.
Lidocaine instills seem to help
For the last few years, urologists throughout the country have been using lidocaine instillations in their IC patients to help relieve symptoms. Two studies at AUA focused on how effective lidocaine is in treating IC symptoms.
Both studies found that by and far lidocaine at least improved the symptoms of the patients studied. The first study came from researchers in New Hyde Park, NY. They studied only eight patients between April and August 2007. Patients’ symptoms were assessed before starting the treatments. Each patient was then given lidocaine instillations to be held in the bladder for 10 minutes. Their symptoms were significantly improved after receiving the instillations.
“These changes were of greater magnitude than expected from previously published effects,” the researchers said. “No adverse events were reported.”
The second study came from researchers in Canada who looked at a specific type of aklaized lidocaine to determine whether it effectively treats IC symptoms. Researchers worked with 102 adult patients diagnosed with IC. Patients were given a daily instillation of lidocaine or a placebo for five consecutive days.
Three times as many patients receiving the lidocaine instillations reported their IC symptoms were moderately or markedly improved on day eight following the treatment. Most of those receiving lidocaine instillations elected to have a second course of treatment. More than half of those reported even greater improvement in their symptoms within one month from the beginning of the study.
The aklkalized lidocaine (PSD597), therefore, seems to be an effective treatment for IC symptoms according to this study. The researchers found that improvements in symptoms were maintained beyond the end of treatment.
Depression and sexual abuse rates are higher in IC patients
While no researcher at AUA asserted that IC is caused by depression or abuse, researchers from Philadelphia did find that the rates of depression and history of sexual abuse in IC patients is significantly higher than that of the general population. The results are a staggering and sobering look at the emotional impact IC has.
Researchers conducted an anonymous study between September 2006 and February 2007 of 141 women who had been diagnosed with IC for at least six months. With a median age of 46, the women completed a survey to identify depression.
Of the 141 patients, 97 (69 percent) had scores indicating depression. Only 9 percent of a comparable group in the general U.S. population is depressed. And of the IC patients who were depressed, a significant number fell into the category of moderate to severe depression.
The research also looked at history of sexual abuse. While 25 percent of the general population reports childhood sexual abuse, the number doubled to 51 percent when looking at the surveyed IC patients.
Researchers found that IC patients were comparable to the general population in a history of physical abuse and that fewer IC patients reported emotional abuse than the U.S. average.
The researchers concluded that since depression and history of sexual abuse are much higher in IC patients then urologists need to screen for these issues and refer patients to a qualified mental health expert for treatment.
Certain nerves seem to be responsible for bladder pain
As urologists begin to delve into research to determine whether IC is solely a bladder condition or whether it is more centralized in the nervous system, a study from researchers in Kyoto, Japan, has at least found that certain nerves seem to be more sensitive in IC and OAB patients.
The research team concluded that C fibers, which have receptors for temperature, body position and pain, are hypersensitive in severe IC and OAB patients. A-delta fibers, which are associated with cold and pressure, also seem to be hypersensitive in this same group.
Studies like these may give researchers insight into how to better treat IC in the future.
Distinguishing between IC and OAB
When symptoms overlap, distinguishing between two different conditions can be a challenge. Urgency is a symptom that both IC and OAB patients report. Urologists are continually looking for the best ways to discern what condition a patient has.
Researchers from Ann Arbor, Mich., and Santa Monica, Calif., conducted a 90-minute phone interview about urgency with 236 IC patients and 125 OAB patients. In comparing the responses from the two groups, more OAB patients reported leakage than IC patients and considered urgency more of a problem. Both patients reported that urgency can occur suddenly or gradually.
The main difference seemed to be that 87 percent of IC patients reported urgency due to pain, pressure or discomfort rather than fear of leakage like with the OAB patients. However, that cannot be the only distinguishing characteristic because approximately half of OAB patients reported urgency due to pain, pressure or discomfort. OAB patients did report more incidents of feeling a sudden sense of urgency with immediate leakage.
First long-term study of bladder removal in IC patients finds success stories
Researchers in Cleveland, Ohio, presented at study looking at the long-term outcome of bladder removal and substitution in patients with refractory IC. What they found is that quality of life tends to improve and stay improved in these patients.
The researchers looked at sexual function, pain relief, voiding symptoms, sleep and overall quality-of-life. The study was conducted with 15 women who had a median age of 37 and a median timeframe six years since their bladder removal. In the survey all the women reported better levels of sexual function and quality-of-life.
The women reported that their sexual function overall was twice as good as it had been before bladder removal. The majority (11 of 15) said they had a marked improvement in pain, voiding symptoms and nighttime sleep. Two reported a moderate improvement in those areas while another two reported a slight improvement.
Mast cells play a major role in IC
Three studies present at AUA reported findings on the relationship between mast cells and IC. The studies confirmed that mast cells most definitely play a role in IC.
The first study, which came from researchers in Chicago, found that mast cells in the bladder cause cystitis pain and bladder inflammation. Through using mice, the researchers found that though mast cells cause such symptoms, antihistamines decrease those symptoms. Thus confirming what patients and doctors have known for a few years in using medications like Vistaril to treat IC symptoms.
The second study came from researchers in Pittsburgh who found that mast cells don’t stay only in the bladder. Mast cells migrate between the colon and bladder, which causes irritation in both organs. This information helps explain why IC and IBS tend to go hand-in-hand for many patients. Both issues are caused by the same type of mast cells. Researchers found that once the colon was irritated, the bladder would be irritated and vice versa.
The last study dealing with mast cells came from researchers in Iowa City, Iowa. This study found that interrupting mast cell function alleviates bladder inflammation. Their conclusion was that targeting mast cells may be a useful approach to treating bladder inflammation causes by conditions such as IC in the future.
Botox may be beneficial in treating IC
Botulinum toxin A has been on urology radars in the last few years as a perhaps promising treatment for IC. Researchers working together from Pittsburgh and Taiwan presented two studies at AUA examining the effect of Botox on bladder inflammation and hyperactivity.
Both studies essentially concluded that Botox does suppress induced bladder inflammation and hyperactivity. One of the studies also concluded that while Botox did alleviate the aforementioned systems, it didn’t affect the spinal cord at all. Basically, Botox works well to treat just the bladder alone.
Gene therapy may be effective
Researchers from Pittsburgh presented a study looking a specific kind of gene therapy used to treat IC. Though it’s in the early stages, the research seems promising when conducted in rats.
Enkephalins are like endorphins in that they are produced during the body’s response to pain. Enkephalins block pain signals to the spinal cord while endorphins block pain at the brain stem. Both are morphine-like substances that function similar to opium-based drugs.
This study looked specifically at the impact of enkephalins and found that symptoms improved when rats with IC were given enkephalin gene therapy. The researchers concluded this may be a potential treatment for pain in IC patients and that the therapy does not have systemic side effects like many oral medications do.