icnmgrjill
10-08-2009, 11:37 AM
The International Continence Society brought their annual meeting to San Francisco this month, just a stones throw from the ICN offices. Several studies were released which we think you'll find interesting! We've summarized them below
Presence of Pelvic Floor Dysfunction in IC and Prostatitis patients
This multicenter examined the pelvic floor of 46 men and women who were enrolled in a therapeutic clinical trial. The goal was to determine what specific physical abnormalities and/or trigger points are found in patients with urologic pain syndromes. The results were compelling with high percentages of trigger points found in the hip girdle musculature (i.e. 72% had trigger points in the adductor muscles) , abdominal wall musculature (i.e. 67% had trigger points in the rectus abdominis) and hip girdle trunk (59% in the piriformis).* Researchers also noted changes in the texture and structure of skin and subcutaneous tissue, possibly due to a decrease in blood flow, in the periurethral space (89%), vulva (76%), labia (68%), thigh, abdominal wall, sacrum and more.*
Clearly, this data indicates that pelvic floor dysfunction is common in men and women with pelvic pain and should be assessed properly and, if needed, treated with physical therapy.
Source:* ICS Poster #264 - Physical Findings In Patients with Urologic Chronic Pelvic Pain Syndromes - Kotarinos R, Fortman C, Neville C, Badillo S, O'Dougherty B, Fraser L, Lynch A, Odabachian L, Sanfield A, Fitzgerald M P, Clemens J Q, Potts J
New Diagnostic Test Using Blood Serum
The research team at Ohio State University are continuing to pursue a new, affordable method of diagnosing IC in humans and cats by studying blood serum. Using infrared microspectroscopy, they have found a serum "signature" common to IC that appears to relate to the concentration of trytophan and/or its metabolites. In this new study, the new test correctly identified IC in all patients. Researchers concluded that* "This research substantiates the potential of the IRMS as a cost-effective, simple and minimally-invasive approach to diagnose IC, and to differentiate patients with IC from those with other urological disorders." This is very promising and we anxiously await further research.
Source: ICS Poster* #265 - Differential Diagnosis of IC/PBS using Infrared Electromicroscopy. Gilleran J, Pozza M, Dimitrakov J, Stella J, Rodriguez-Saona L, Buffington T
National Failure Rates for Sacral Neuromodulation Higher Than Expected
Isn't it important to know what the potential benefits and risks of a possible therapy could be before you make the decision to have that treatment? With sacral neuromodulation, that data has been awfully hard to come by. Yes, some clinics have published high success rates but we've never had a good national study until* now. This study looked at a random sample of Medicare beneficiaries from 1997-2007 who underwent SNM. Those that had percutaneous test lead technique experienced a 45.6% failure rate. Those who had two stage surgical technique had a whopping 62.7% failure rate. According to the authors "This success rate is inferior to previously published results and may reflect the older, more disabled population served by Medicare. Women and younger individuals, however, had greater success rates in this study."
Source: ICS Poster #128 - National Trends in the Usage and Success of Sacral Neuromodulation - Cameron AP, Anger JT, Madison R, Saigal S, Clemens JQ, Urologic Diseases in America Project - University of Michigan, UCLA, RAND corporatio
Pudendal Nerve Stimulation An Alternative to Sacral Neuromodulation
IC researcher extraordinaire Dr. Ken Peters (Beamont Hospital, Royal Oak MI), considered one of the best surgeons in the country for neuromodulation, revealed compelling data about the use of pudendal nerve stimulation. Of 84 patients (from 2003-2008) who underwent pudendal lead placement, 44 of these patients had failed previous sacral neuromodulation. Overall, 55/84 patients responded to pudendal neuromodulation and had a pulse generator placed. 41/44 previous sacral failures had a positive response with pudendal stimulation and went on to 2nd stage implantation. Five revisions were necessary, two for pain and three for lead migration. The authors offered that over 92% of patients who failed to respond to sacral nerve stimulation responded to pudendal stimulation. "Patients continued to use their device, were generally satisfied and indicated that if given the chance they would recommend the treatment to a friend. Complications (lead migration, painful stimulation, and infection) and reoperations were minimal in comparison to published studies on sacral neuromodulation."
Source: ICS Poster #14 -* Pudendal Nerve Stimulation is a Viable Alternative To Sacral Nerve Stimulation in Voiding Dysfunction - Peters K, Killinger K, Boguslawski B - William Beaumont Hospita
Bladder Symptoms in Women With Hyperthyroid
While some IC patients report that they struggle with low thyroid (hypothyroidism), here's a research study that shows that women struggling with high thyroid experience quite a few bladder symptoms. Sixty five newly diagnosed hyperthyroid had significantly higher urinary frequency, incomplete emptying, straining and lower flow rates. After treatment for thyroid, their symptoms improved. Additional research is needed to understand why this occurs but it is VERY interesting! It might be worth getting your thyroid levels checked!
Source: ICS Poster #155 - Lower Urinary Tract Symptoms in Female Patients With Hyperthyroidism - Ho C, Yu H, Huang K, Department of Urology, National Taiwan University Hospital
Got Fatigue?
Researchers at Loyola University took a closer look at the patient journals written by IC patients who were participating in a clinical trial. These journals gave a glimpse of the major issues and frustrations that IC patients often struggle with. While 81% of those participating described pain, a surprising 32% of patients also reported suffering from fatigue throughout the day and a lack of energy to participate in events with family and friends. Fatigue hasn't been previously identified as a symptom of IC and prostatitis, thus revealing a potential new symptom that should be assessed in patients. Source: ICS Poster #459 - Life Impact of Urologic Pain Syndromes - Hatchett L, Fitzgerald M P, Potts J, Winder A, Mickelberg K, Barrell T, Kusek J - Loyola University Medical Center,
Treatments For Hunner's Ulcers Found Successful
Thirty patients with Hunner's Ulcers received injections of triamcinolone into the center and periphery of the ulcer as a therapy, experiencing both reduction of frequency, urgency, pain, number of nighttime voids and a reduction of discomfort related to intimacy. Though this study has some flaws, particularly a very short follow up time, this represents a novel new method of treating Hunner's Ulcers. Researchers will follow these patients for a year to monitor their progress.
Source: ICS Poster * #204 - Assessment of Patient Outcomes Following Submucosal Injection of Triamcinolone For Treatment of Hunner's Ulcer Subtype Inerstitial Cystitis - Cox M, Kltuke J, Klutke C, Washington University in St. Louis, & University of Southern California
Researchers in Japan studied the effectiveness of transurethral resection (i.e. surgical removal of Hunner's Ulcers) as a treatment for severe ulcerative IC. Post surgically, patients who had Hunner's Ulcers removed had a dramatic improvement in pain scores.. such that they could not be distinguished from non ulcerative IC patients. They conclude "Transurethral resection of ulcers appears to be one of the most promising therapeutic options for patients with ulcer type IC."*
Source: ICS Poster #461 - Transurethral resection of ulcerative tissue for ulcer type interstitial cystitis. - Nomiya A, Homma Y, Nishimatsu H, Fujimura T, Kumano S, Tsurumaki Y, Takeuchi T - Department of Urology, Tokyo University
Researchers at the Medical College of Wisconsin shared the results of a similar study, though in this case Hunner's Ulcers were abladed via fulguration. Of the 14 patients studied, 86% had a substantial improvement in their symptoms following treatment, including a 50% reduction in pain. Frequency was reduced from 21.7 to 9.7 after treatment. Eight patients had symptoms which did not recur after an average 27 months of follow up care. Four of the patients did have a return of their symptoms within a year, each associated with a return of the ulcer in the same position. Retreatment of the ulcer resulted in complete symptom resolution. No complications from treatment were reported.
Source: ICS Poster #460 - Endoscopic Ablation of Hunner's Lesions in IC Patients - Guralnick M, Payne R, Kressin M, O'Connor R -* Medical college of Wisconsin
Is IC a Neurological disorder?
One term you will* be hearing for years to come in IC research discussions is "neurosensitization."* Is our nervous system in the pelvis functioning normally? In IC, it appears that the normally silent nerve pathways, the C-fiber afferent pathway that controls pain as the bladder fills with urine, has become more easily activated/sensitized/hyperexcited. Researchers in Italy sought to determine if the normal pain pathways in IC patients have been changed. In a study of 14 IC patients and 10 control subjects, they found that IC patients had much lower pain thresholds than controls "giving direct evidence that a hyper excitability of spinal nociceptive processes is present in PBS/IC patients." More on this to come in future studies.
Source:* ICS Poster #266 - Defective Spinal Modulation of Nociceptive Processing in Patients with IC/PBS May Play An Essential Role in the Pathophysiology of the Disease. - Malaguti S, Mako A, Natale F, Lamarche J, Cervigni M
Ketamine Bladder Damage Now Found in the UK
Researchers in the UK have released their first study demonstrating that ketamine abuse can cause severe bladder damage. 20 patients with a history of regular ketamine use presented with symptoms comprising haematuria, suprapubic pain, frequency and urgency. Cystoscopy revealed bladder inflammation. Biopsy samples revealed haemorrhagic cystitis. Researchers found that bladder symptoms reduced when ketamine use was discontinued though the bladder damage could be severe and irreversible. Urologists throughout the UK "revealed similar cases in all regions of the UK."* Find more information on ketamine at: http://www.ketaminebladdersyndrome.com
Source: ICS Poster #208 - Painful Bladder and Urinary Tract Pathology Associated with Long Term Ketamine Use. - D. Gillat
Potty Posture
Anyone remember Jill's editorial on potty posture years ago?? Researchers in Japan sought to determine which position (sitting, sitting with hips flexed or squatting) was the most comfortable and efficient for having a bowel movement. They recruited six healthy volunteers who had a variety of measurements taken during various positions (OMG.. those were very brave participants) and determined that squatting, which caused a greater flexion of the hips, provided a "straighter recto anal canal" which created less strain required for defacation. Nuff said!!
Source: ICS Poster #381 - Influence of Body Position on Defacation - Sakakibara R, Tsunoyama K, Hosoi H, Takahashi O, Sugiyama M, Kishi M, Ogawa E, Terada H, Uchiyama T, Yamanishi T - Japan
Presence of Pelvic Floor Dysfunction in IC and Prostatitis patients
This multicenter examined the pelvic floor of 46 men and women who were enrolled in a therapeutic clinical trial. The goal was to determine what specific physical abnormalities and/or trigger points are found in patients with urologic pain syndromes. The results were compelling with high percentages of trigger points found in the hip girdle musculature (i.e. 72% had trigger points in the adductor muscles) , abdominal wall musculature (i.e. 67% had trigger points in the rectus abdominis) and hip girdle trunk (59% in the piriformis).* Researchers also noted changes in the texture and structure of skin and subcutaneous tissue, possibly due to a decrease in blood flow, in the periurethral space (89%), vulva (76%), labia (68%), thigh, abdominal wall, sacrum and more.*
Clearly, this data indicates that pelvic floor dysfunction is common in men and women with pelvic pain and should be assessed properly and, if needed, treated with physical therapy.
Source:* ICS Poster #264 - Physical Findings In Patients with Urologic Chronic Pelvic Pain Syndromes - Kotarinos R, Fortman C, Neville C, Badillo S, O'Dougherty B, Fraser L, Lynch A, Odabachian L, Sanfield A, Fitzgerald M P, Clemens J Q, Potts J
New Diagnostic Test Using Blood Serum
The research team at Ohio State University are continuing to pursue a new, affordable method of diagnosing IC in humans and cats by studying blood serum. Using infrared microspectroscopy, they have found a serum "signature" common to IC that appears to relate to the concentration of trytophan and/or its metabolites. In this new study, the new test correctly identified IC in all patients. Researchers concluded that* "This research substantiates the potential of the IRMS as a cost-effective, simple and minimally-invasive approach to diagnose IC, and to differentiate patients with IC from those with other urological disorders." This is very promising and we anxiously await further research.
Source: ICS Poster* #265 - Differential Diagnosis of IC/PBS using Infrared Electromicroscopy. Gilleran J, Pozza M, Dimitrakov J, Stella J, Rodriguez-Saona L, Buffington T
National Failure Rates for Sacral Neuromodulation Higher Than Expected
Isn't it important to know what the potential benefits and risks of a possible therapy could be before you make the decision to have that treatment? With sacral neuromodulation, that data has been awfully hard to come by. Yes, some clinics have published high success rates but we've never had a good national study until* now. This study looked at a random sample of Medicare beneficiaries from 1997-2007 who underwent SNM. Those that had percutaneous test lead technique experienced a 45.6% failure rate. Those who had two stage surgical technique had a whopping 62.7% failure rate. According to the authors "This success rate is inferior to previously published results and may reflect the older, more disabled population served by Medicare. Women and younger individuals, however, had greater success rates in this study."
Source: ICS Poster #128 - National Trends in the Usage and Success of Sacral Neuromodulation - Cameron AP, Anger JT, Madison R, Saigal S, Clemens JQ, Urologic Diseases in America Project - University of Michigan, UCLA, RAND corporatio
Pudendal Nerve Stimulation An Alternative to Sacral Neuromodulation
IC researcher extraordinaire Dr. Ken Peters (Beamont Hospital, Royal Oak MI), considered one of the best surgeons in the country for neuromodulation, revealed compelling data about the use of pudendal nerve stimulation. Of 84 patients (from 2003-2008) who underwent pudendal lead placement, 44 of these patients had failed previous sacral neuromodulation. Overall, 55/84 patients responded to pudendal neuromodulation and had a pulse generator placed. 41/44 previous sacral failures had a positive response with pudendal stimulation and went on to 2nd stage implantation. Five revisions were necessary, two for pain and three for lead migration. The authors offered that over 92% of patients who failed to respond to sacral nerve stimulation responded to pudendal stimulation. "Patients continued to use their device, were generally satisfied and indicated that if given the chance they would recommend the treatment to a friend. Complications (lead migration, painful stimulation, and infection) and reoperations were minimal in comparison to published studies on sacral neuromodulation."
Source: ICS Poster #14 -* Pudendal Nerve Stimulation is a Viable Alternative To Sacral Nerve Stimulation in Voiding Dysfunction - Peters K, Killinger K, Boguslawski B - William Beaumont Hospita
Bladder Symptoms in Women With Hyperthyroid
While some IC patients report that they struggle with low thyroid (hypothyroidism), here's a research study that shows that women struggling with high thyroid experience quite a few bladder symptoms. Sixty five newly diagnosed hyperthyroid had significantly higher urinary frequency, incomplete emptying, straining and lower flow rates. After treatment for thyroid, their symptoms improved. Additional research is needed to understand why this occurs but it is VERY interesting! It might be worth getting your thyroid levels checked!
Source: ICS Poster #155 - Lower Urinary Tract Symptoms in Female Patients With Hyperthyroidism - Ho C, Yu H, Huang K, Department of Urology, National Taiwan University Hospital
Got Fatigue?
Researchers at Loyola University took a closer look at the patient journals written by IC patients who were participating in a clinical trial. These journals gave a glimpse of the major issues and frustrations that IC patients often struggle with. While 81% of those participating described pain, a surprising 32% of patients also reported suffering from fatigue throughout the day and a lack of energy to participate in events with family and friends. Fatigue hasn't been previously identified as a symptom of IC and prostatitis, thus revealing a potential new symptom that should be assessed in patients. Source: ICS Poster #459 - Life Impact of Urologic Pain Syndromes - Hatchett L, Fitzgerald M P, Potts J, Winder A, Mickelberg K, Barrell T, Kusek J - Loyola University Medical Center,
Treatments For Hunner's Ulcers Found Successful
Thirty patients with Hunner's Ulcers received injections of triamcinolone into the center and periphery of the ulcer as a therapy, experiencing both reduction of frequency, urgency, pain, number of nighttime voids and a reduction of discomfort related to intimacy. Though this study has some flaws, particularly a very short follow up time, this represents a novel new method of treating Hunner's Ulcers. Researchers will follow these patients for a year to monitor their progress.
Source: ICS Poster * #204 - Assessment of Patient Outcomes Following Submucosal Injection of Triamcinolone For Treatment of Hunner's Ulcer Subtype Inerstitial Cystitis - Cox M, Kltuke J, Klutke C, Washington University in St. Louis, & University of Southern California
Researchers in Japan studied the effectiveness of transurethral resection (i.e. surgical removal of Hunner's Ulcers) as a treatment for severe ulcerative IC. Post surgically, patients who had Hunner's Ulcers removed had a dramatic improvement in pain scores.. such that they could not be distinguished from non ulcerative IC patients. They conclude "Transurethral resection of ulcers appears to be one of the most promising therapeutic options for patients with ulcer type IC."*
Source: ICS Poster #461 - Transurethral resection of ulcerative tissue for ulcer type interstitial cystitis. - Nomiya A, Homma Y, Nishimatsu H, Fujimura T, Kumano S, Tsurumaki Y, Takeuchi T - Department of Urology, Tokyo University
Researchers at the Medical College of Wisconsin shared the results of a similar study, though in this case Hunner's Ulcers were abladed via fulguration. Of the 14 patients studied, 86% had a substantial improvement in their symptoms following treatment, including a 50% reduction in pain. Frequency was reduced from 21.7 to 9.7 after treatment. Eight patients had symptoms which did not recur after an average 27 months of follow up care. Four of the patients did have a return of their symptoms within a year, each associated with a return of the ulcer in the same position. Retreatment of the ulcer resulted in complete symptom resolution. No complications from treatment were reported.
Source: ICS Poster #460 - Endoscopic Ablation of Hunner's Lesions in IC Patients - Guralnick M, Payne R, Kressin M, O'Connor R -* Medical college of Wisconsin
Is IC a Neurological disorder?
One term you will* be hearing for years to come in IC research discussions is "neurosensitization."* Is our nervous system in the pelvis functioning normally? In IC, it appears that the normally silent nerve pathways, the C-fiber afferent pathway that controls pain as the bladder fills with urine, has become more easily activated/sensitized/hyperexcited. Researchers in Italy sought to determine if the normal pain pathways in IC patients have been changed. In a study of 14 IC patients and 10 control subjects, they found that IC patients had much lower pain thresholds than controls "giving direct evidence that a hyper excitability of spinal nociceptive processes is present in PBS/IC patients." More on this to come in future studies.
Source:* ICS Poster #266 - Defective Spinal Modulation of Nociceptive Processing in Patients with IC/PBS May Play An Essential Role in the Pathophysiology of the Disease. - Malaguti S, Mako A, Natale F, Lamarche J, Cervigni M
Ketamine Bladder Damage Now Found in the UK
Researchers in the UK have released their first study demonstrating that ketamine abuse can cause severe bladder damage. 20 patients with a history of regular ketamine use presented with symptoms comprising haematuria, suprapubic pain, frequency and urgency. Cystoscopy revealed bladder inflammation. Biopsy samples revealed haemorrhagic cystitis. Researchers found that bladder symptoms reduced when ketamine use was discontinued though the bladder damage could be severe and irreversible. Urologists throughout the UK "revealed similar cases in all regions of the UK."* Find more information on ketamine at: http://www.ketaminebladdersyndrome.com
Source: ICS Poster #208 - Painful Bladder and Urinary Tract Pathology Associated with Long Term Ketamine Use. - D. Gillat
Potty Posture
Anyone remember Jill's editorial on potty posture years ago?? Researchers in Japan sought to determine which position (sitting, sitting with hips flexed or squatting) was the most comfortable and efficient for having a bowel movement. They recruited six healthy volunteers who had a variety of measurements taken during various positions (OMG.. those were very brave participants) and determined that squatting, which caused a greater flexion of the hips, provided a "straighter recto anal canal" which created less strain required for defacation. Nuff said!!
Source: ICS Poster #381 - Influence of Body Position on Defacation - Sakakibara R, Tsunoyama K, Hosoi H, Takahashi O, Sugiyama M, Kishi M, Ogawa E, Terada H, Uchiyama T, Yamanishi T - Japan