The Potassium Sensitivity Test

[icnmgrjill]

IC Great Debates - The Potassium Sensitivity Test

This summer, Dr. Lowell Parsons (UC-San Diego) and Dr. Phil Hanno (Univ. of PA) squared off in the Journal of Urology to debate the merits of the potassium (KCL) sensitivity test. Dr. Parsons, well-known for his work with Elmiron, created the KCL test several years ago as a quick, fairly easy method of determining if a patient could have* interstitial cystitis. It works by introducing two solutions into the bladder, a water solution and a potassium solution. Water should not irritate a healthy bladder but potassium, when placed on a wound, creates discomfort. Thus, IC patients usually react and feel some discomfort when potassium is placed in their bladders. This result suggests that the bladder wall is not intact (aka damaged) and that IC is the likely suspect.

Dr. Phil Hanno has been a frequent critic of the KCL test. He correctly states that it does not differentiate beteween IC and other conditions of the bladder, could generate false positive or false negative results and that it is not reliable predictor for treatment responses.

Who is right? Well, they both are. The great thing about the KCL test is that it can help doctors, particularly Ob-Gyns, determine if pelvic pain is coming from the bladder. If a patient does have a reaction, then it's clear that they need to have a proper urological workup. I don't believe that Dr. Parsons has ever suggested that this is the perfect test for IC but it is, hands down, much easier to go through than a hydrodistention with cystoscopy. The debate continues!

We'd like to thank Dr. Parsons for sticking his neck out, yet again, to find new, innovative tools to help patients and clinicians working with IC. Dr. Hanno continues to be one of the most prolific and respected writers in the IC community.

Your thoughts?

Source: Parsons CL The potassium sensitivity test: a new gold standard for diagnosing and understanding the pathophysiology of interstitial cystitis. J Urol. 2009 Aug;182(2):432-43

Hanno P. Potassium sensitivity test for painful bladder syndrome/interstitial cystitis: con. J Urol. 2009 Aug;182(2):431-2, 434.

[wfarrell]

I am so happy to have the potassium test, my gyno did this and she was very sure I had IC and suggested to go to urologist or gyno/urologist. I did and still had a hydro done but I was so glad that she really saw the pain I was in from the potassium test she knew there were really issues going on.

[pacer1]

I had no reaction to this test so,therefore, the urologist dismissed me and sent me back to my internist. It was a year later and after months of agonizing pain that I went to Johns Hopkins and was diagnosed. If the test had been positive then I would have received treatment earlier. That is the reason that I feel that the test can
effect early treatment and is questionable.

[CindyLu]

When I finally found a urologist that was willing to test me for IC after 2 years of pain, he did the potassium sensitivity test. I didn't have an extreme reaction to the potassium but he diagnosed me as having mild IC. There was nothing mild about my pain, but because my bladder looked healthy to him and because I didn't feel an intense worsening of my pain from the potassium I guess that was a reasonable assumption. He started me on Elmiron right away, and after a year of Elmiron treatment, I can say that although I am not 100% or flare-free, I am certainly improved. So I would say that my diagnosis was more by exclusion than the PST.

[ddktt]

How much does this test cost?

Say you have a negative UTI culture so that's ruled out.

If you drink a glass of lemon juice or something acidic and your bladder burns would that not be telling you that there is a problem with the bladder? Would that not be the time to start with conservative treatment protocols suggested on this site (i.e. diet, supplements) to see if there is improvement.

I would agree with Hanno. This test does not sound that definitive to me.

Perhaps if the pain was totally diffuse and could not be pinpointed to the bladder then it might be useful.

[Lou]

My bladder burned for weeks after the "quick" potassium test, and even then my urologist wasn't "sure". I changed urologists, has a cystoscopy under anaesthetic and got a diagnosis due to hunner's ulcers. You usually end up having to have the cystoscopy anyway -- the potassium test is cruel, in my estimation.

[happymom]

I would advise carefully researching this test before haivng it done. When I had the PST, it was adminstered after a bladder distention and hydroscopy. The word test sounded so harmless that I didn't research it. One day I walked into the doctors office with minor bladder problems and left with excrutiating pain. I had to quit my job and have been on narcotic pain killers ever since! For some people, this test causes no problems and they go on to live regular lives. If I could do it again, I would have choosen a less invasive method to diagonse IC.

[CindyLu]

I live in Canada, so the test is free. All our health care is free. The medications are not.

[carlag]

I don't think the pain from this test is worth it. I've talked to others who say the same thing.

IC Great Debates - The Potassium Sensitivity Test

This summer, Dr. Lowell Parsons (UC-San Diego) and Dr. Phil Hanno (Univ. of PA) squared off in the Journal of Urology to debate the merits of the potassium (KCL) sensitivity test. Dr. Parsons, well-known for his work with Elmiron, created the KCL test several years ago as a quick, fairly easy method of determining if a patient could have* interstitial cystitis. It works by introducing two solutions into the bladder, a water solution and a potassium solution. Water should not irritate a healthy bladder but potassium, when placed on a wound, creates discomfort. Thus, IC patients usually react and feel some discomfort when potassium is placed in their bladders. This result suggests that the bladder wall is not intact (aka damaged) and that IC is the likely suspect.

Dr. Phil Hanno has been a frequent critic of the KCL test. He correctly states that it does not differentiate beteween IC and other conditions of the bladder, could generate false positive or false negative results and that it is not reliable predictor for treatment responses.

Who is right? Well, they both are. The great thing about the KCL test is that it can help doctors, particularly Ob-Gyns, determine if pelvic pain is coming from the bladder. If a patient does have a reaction, then it's clear that they need to have a proper urological workup. I don't believe that Dr. Parsons has ever suggested that this is the perfect test for IC but it is, hands down, much easier to go through than a hydrodistention with cystoscopy. The debate continues!

We'd like to thank Dr. Parsons for sticking his neck out, yet again, to find new, innovative tools to help patients and clinicians working with IC. Dr. Hanno continues to be one of the most prolific and respected writers in the IC community.

Your thoughts?

Source: Parsons CL The potassium sensitivity test: a new gold standard for diagnosing and understanding the pathophysiology of interstitial cystitis. J Urol. 2009 Aug;182(2):432-43

Hanno P. Potassium sensitivity test for painful bladder syndrome/interstitial cystitis: con. J Urol. 2009 Aug;182(2):431-2, 434.

[carlag]

You are so lucky to have free healthcare. And I know that your drugs are cheaper too because I get some from there and pay about half what I do here.

I live in Canada, so the test is free. All our health care is free. The medications are not.

[77amy]

I had a terrible reaction to the potassium test. And by terrible I mean I simultaneously burst into tears and kicked the urologist. Worst pain ever.

If you think you have I.C. DO NOT GET THIS TEST. If you think you have a UTI, DO NOT GET THIS TEST. Get a cystoscopy under sedation. Or try the diet and see if you get better. Or any other option your doctor recommends.

[aritchie88]

I agree that this particular test is a bad idea. I was given the test by my Gyno and she assessed from my sudden and intense bladder pain that I had a moderate case of IC. I have never had bladder pain before this, but after, I was in severe pain for two straight months. Meds nor diet did anything to help. I went to a Urologist who has determined that I do not have IC, rather the test put my bladder in a cronic state of inflamation. The teat gave a false positive for IC, when really I had some reaction to the potassium that my Uro had never seen before to this extent. I am now undergoing two "bladder coctails" a week to clear up the inflamation and I had instant releif after the first treatment. My Uro would not have given me the test based on my symptoms and not sure why the Gyno did. I would suggest that if a Gyno thinks you might have IC, go to a Uro for conformation, and do your reasearch.

[bluetou]

Canadians healthcare may look free....but we do pay through the sales taxes on items we buy in a store..... Each item we buy in the store is taxed, and it goes towards our healthcare. It is a good way to pay for our health care. (HST - health sales tax) is what it is called.

We do have the most high quality of health care, it is excellent, but we do pay for it through our taxes.

As far as medications go...depending on your health care plan from your "worK", we pay NOTHING for our meds....others pay 80 percent, some pay 50 percent....it all depends on what your work employment offers for health care benefits.

Peace
Blue
:pray:

You are so lucky to have free healthcare. And I know that your drugs are cheaper too because I get some from there and pay about half what I do here.

[maryla]

Personally, I have never had one but I think they are barbaric!! At least with a hydro you are asleep and they tend to help with pain.

Hugs and blessings

[kathryn6443]

I would advise carefully researching this test before haivng it done. When I had the PST, it was adminstered after a bladder distention and hydroscopy. The word test sounded so harmless that I didn't research it. One day I walked into the doctors office with minor bladder problems and left with excrutiating pain. I had to quit my job and have been on narcotic pain killers ever since! For some people, this test causes no problems and they go on to live regular lives. If I could do it again, I would have choosen a less invasive method to diagonse IC.

i also feel that my pelvic pain is worse after i was diagnosed via potassium sensitivity test two weeks ago...can you give me more info...i tested positive for IC (from what doc told me), and ever since i have been in worse pain than i was before, and i dont know if it is the elmiron or did the test cause more harm than good? let me know...

[txbutrfly22]

I would advise carefully researching this test before haivng it done. When I had the PST, it was adminstered after a bladder distention and hydroscopy. The word test sounded so harmless that I didn't research it. One day I walked into the doctors office with minor bladder problems and left with excrutiating pain. I had to quit my job and have been on narcotic pain killers ever since! For some people, this test causes no problems and they go on to live regular lives. If I could do it again, I would have choosen a less invasive method to diagonse IC.

I agree that this particular test is a bad idea. I was given the test by my Gyno and she assessed from my sudden and intense bladder pain that I had a moderate case of IC. I have never had bladder pain before this, but after, I was in severe pain for two straight months. Meds nor diet did anything to help. I went to a Urologist who has determined that I do not have IC, rather the test put my bladder in a cronic state of inflamation. The teat gave a false positive for IC, when really I had some reaction to the potassium that my Uro had never seen before to this extent. I am now undergoing two "bladder coctails" a week to clear up the inflamation and I had instant releif after the first treatment. My Uro would not have given me the test based on my symptoms and not sure why the Gyno did. I would suggest that if a Gyno thinks you might have IC, go to a Uro for conformation, and do your reasearch.

I am new to this network; I only joined because I read your posts. I have a fabulous OB/GYN/gynourologist, he has worked as my GYN actually for 5 years, he performed my hysterectomy 2 years ago, we have a very good working relationship, and trusting. When I started having problems again we of course started taking action on my ovaries, however nothing seemed to be working. I was diagnosed with endometriosis in 2003, but it was actually never found, and it was not on my pathology report from my hysterectomy either. This lead my doctor to believe that I have IC, on March 30th I went in for a follow up. I was asked if I ever had a check on my bladder, I told him no. He explained to me that IC has many of the same symptoms as endometriosis and that it is frequently misdiagnosed. At this point it is check my bladder, or remove my ovaries (which I do not want to do) He told me about the PST test, I told him “ok, let’s do it!” I want to make sure we do everything in our power, and check everything before we go to the extreme of taking my ovaries. The water was fine; once he installed the second solution (the potassium), I started feeling the urgency to urinate, so badly that I literally thought I was going to have an accident right there on my doctor or his nurse! However, it did not burn, not yet. They let me get up and go to the restroom, in there that is when it started to burn, and bleed. When I got back in the room, I could not sit down it hurt so bad, but at that time I did not think anything unusual was going on, it was supposed to hurt right? I spent the next 24 hours going to the restroom every 10 minutes, I practically lived on the toilet, I ended up getting bruises on my legs because all I could do is sit there, in pain and tears! I could not go to work, I couldn’t sleep, I didn’t eat, I could do nothing but go to the bathroom, and cry, and bleed. I called my doctor’s office the next night and explained to them the situation the nurse said that they could test me for a bladder infection and do a “rescue treatment” if I did not have an infection, to come in first thing in the morning. I went in the nurse could not get the catheter in to do the rescue treatment because I was so inflamed. When my doctor came in he was appalled, he said that it seemed as if I had some sort of reaction to the potassium and that I had burns and lacerations not only internally on my bladder, but externally as well. I was put on five different medications and lidocaine for the external burns and told to come back the following afternoon to check me before the weekend, they did not do the rescue treatment at that time. Friday afternoon I went in I did was worse not better, he did the rescue treatment, however there was no success in that treatment. Monday I had surgery a cystoscopy my doctor also called in an urologist to assist. (Now I have two doctors on the case with a combined 50 years of experience, neither of which have ever seen or heard of this) This was supposed to be a day surgery; I ended up in the hospital for 5 days after my procedure. They installed a catheter and it is still in, it has been 4 weeks, and I feel like I am dying (it’s just the pain I know I’m not). They tried to take it out last Thursday; however, the pain was still unbearable, they had to put it back in on Friday, at that time they tried to do another rescue treatment, but my bladder rejected it. I still cannot work, or do anything with my family, how do you live like this? I am 27 years old and I have IC, I have 3 children, and I am stuck in bed for most of my life, I can do next to nothing. I am on narcotic pain relievers, but they only help very little, I think I am becoming immune to them. I cannot sleep (this week he put me on Ambien to force me to sleep), and I hardly eat. What do I do?

[Annie2]

We always have to be mindful that we are all different. There are so many negative comments here and I just want to pipe in and say I am one for whom the Potassium Sensitivity Test was absolutely the right way to go and I had no problems with it. I know it isn't right for everyone, but it isn't totally vile either. For me, a hydrodistention was far too invasive and had much greater risk than the PST.

One of the key problems with this test is getting medical professionals to administer the test properly. Unfortunately, not all medical professionals are properly trained in administering this test. Once the potassium chloride solution has been instilled, the second the patient reacts to the solution it needs to be drained by catheter from the bladder and then IMMEDIATELY following draining a rescue solution needs to be instilled into the bladder to stop the KCL reaction and soothe the irritated tissue. This rescue solution should then be held in the bladder for a period of time sufficient for it to do it's intended job.

Allowing the KCL solution to remain in the bladder for any length of time or having the patient void the KCL solution (dangerous because the bladder may not completely drain the solution and voiding also allows KCL to come in contact with the urethral tissue and external genitalia) is not proper technique and can cause harm to the patient. If the patient is asked to void normally to drain the KCL solution, then the patient must be catheterized again for a rescue solution to be instilled. Instillation of a rescue solution immediately after the test is absolutely and unequivocally mandatory.

Unfortunately, there are always some who will have extreme reactions to this test and their experience with it then will understandably be negative. But the same can be said for cystoscopy with hydrodistention. Neither test is anywhere near 100% accurate. It really does point out the desperate need for the development of a non-invasive and accurate urine test. Let's all hope and pray this will be available soon and this great debate will be a thing of the past.

[ICNDonna]

Annie is correct! The catheter should not be removed until the potassium solution has been drained and an analgesic instilled. The potassium should not be left in the bladder to be urinated out through the urethra.Donna

[VickiB]

I was thinking along the same lines as Annie, it didn't sound right to me that you were allowed to void the potassium, and no follow-up of a bladder rescue solution was mentioned. At the same time, I didn't say anything for not wanting to criticize a doctor's methods. I know a long time ago I had a horrible experience at the hands of a uro and I came away thinking the procedure was absolutely barbaric. In hindsight, I now believe it was the doctor who was barbaric in the application of the procedure, and he really should've known better!

I am one for whom the Potassium Sensitivity Test was absolutely the right way to go and I had no problems with it. I know it isn't right for everyone, but it isn't totally vile either. For me, a hydrodistention was far too invasive and had much greater risk than the PST.
This is exactly how I feel as well. The PST was the right diagnostic tool for me.

Vicki

[astone0611]

I'm really greatful towards my urologist for doing the PST. He did say I might still have to do a cystoscopy if there was blood in my urine come my next visit. Luckily...no blood...no cystoscopy :woohoo: I could barely handle the pediatric cather they used for the PST...so I was making myself sick with painful flares from stress of possibly having to do the cystoscopy. I'm also happy that the meds I'm taking now is actually helping...I don't think I would be able to make it through any instills :shake:

[squirrel]

At least with a hydro you are asleep and they tend to help with pain.



Unfortunately I have to disagree...
Hydrodistension brought my IC to a whole new level of pain and urgency...my bladder felt like you were slicing it uo with a knife, using a spoon to scratch out the whole mucous lining, pouring acid on it afterwards and pulsing the whole time for more than 8 weeks...I had hydro done 5 years ago and my bladder has never been worse...
I know a lot of other IC patients who had quite similar results...People used to think that hydrodistension was "part of IC therapy", but that's definetely not the case for a lot of patients

[statesboro]

I do realize the original thread was started last year. OK. I did not read every single post, but I do want to state something now. It has to do with what I was reading in the ICA Update recently. Yep! AUA IC Guidelines at a Glance Maybe some more of you have read it all by now. It states that cystoscopy and urodynamics shouldn't be routine. OK. It also states the potassium sensitivity test should not be used. Yep! It also states that if you don't have signs of others things going on, a diagnoses can be made based on symptoms, physical examination, and lab tests. OK. I read, too, that if a man's condition fits the same criteria that he can be assumed to have IC. OK. That was what was presented at the 2010 meeting. Yep!

[bob04951]

My husband had the PST done in doctor's office after prostate surgery did not fix his problems of urgency and some pain. The doctor did a quick scope of his bladder in office which was painful but only took a second. To confirm IC, he did the PST and immediately had to withdraw it as my husband went through the roof, and gave him a rescue instill, which immediately took away the pain. However, his IC has gotten progressively worse since that time. Makes me wonder...

[Sasapippi]

Hi All,

I had a cystoscopy and PST done earlier this week. I was actually amazed that the cystoscopy was pretty painless- maybe I just have a good doctor but they first put in some numbing gel so that probably helped too. The PST was very painful and I started crying but the Dr. drained my bladder and then put in a rescue solution. I do have to say I felt pretty bad for the rest of the day but by morning most of the pain had gone away. I'm glad I was able to be diagnosed this way as I am scared to death of being put under general anesthesia.

[nekura]

I for one would only let a scope go in me if I was under GA regardless of hydro or not.

These other methods are just brutal and barbaric.