It was an attempt to gauge the current level of interest in painful bladder syndrome and the state of care of the disorder across the Asian nations. The meeting was sponsored by the Taiwan Continence Society. Urologists from Taiwan, Japan, Korea, Hong Kong, China, and Malaysia participated in the proceedings along with Philip Hanno, MD, U. Pennsylvania, USA. It is anticipated that this was the first of Pan-Asian meetings on painful bladder syndrome - interstitial cystitis to be held annually. Tomohiro Ueda, MD, PhD, Clinical Professor and Chief of Urology in Kyoto City Hospital, Japan discussed problems inherent in performing an epidemiologic study of PBS/IC. The symptoms of PBS/IC are different from those of overactive bladder, but they are not easy to separate out in a population-based survey because of significant overlap. He pointed out that urinary tract infection may be misinterpreted by the survey respondent as painful bladder/interstitial cystitis. He concluded that the prevalence of PBS/IC is probably much higher in Japan than is generally believed, but further studies will be needed to confirm this assumption.

Ming-Huei Lee, MD, Chief of the Division of Urology, Taichung Hospital, Taichung, Taiwan reviewed the ongoing interstitial cystitis data base project in Taiwan. Three hundred nineteen patients have been enrolled in the last 2 years. Of all enrollees, 86% were female and the average age at onset was 37 years. Frequency was reported in 94% of patients and pain in 52%. Prior to this meeting, many urologists in Asia did not ask patients about bladder "pressure", and apparently many patients do not equate discomfort and pressure with pain. This issue, which may be one of terminology, may account for the fact that pain was reported in only 52% of patients. Pain occurred with filling in 83% of those complaining of it, and was relieved by voiding in 74%. Pineapples and oranges were the most irritating of foods. Further interesting data is anticipated from this ongoing study.

Shing-Hwa Lu, MD, PhD, Associate Professor of Urology, Taipei's National Yang-Ming University discussed the role of medical treatment in interstitial cystitis. He discussed the use of pentosan polysulfate and other oral medications including analgesics, antispasmodics, antidepressants and antihistamines. He also discussed intravesical therapy. In Taiwan, the government regulates the use of pentosan polysulfate. It can only be administered in patients with a finding of glomerulations or Hunner's ulcer on bladder hydrodistention and a voiding diary showing significant frequency. It is only offered for a 6 month course of treatment. Urologists in Taipei are working to liberalize its use in the future. Multimodal therapy was recommended in this presentation.

Hann-Chorng Kuo, MD, Professor of Urology at the Buddhist Tzu Chi University School of Medicine, Hualien, Taiwan discussed new therapeutic approaches. He discussed the range of recently published papers detailing results of oral, intravesical, neuromodulation, and surgical therapies.

Dr. Lin reviewed the literature on psychological aspects of painful bladder/interstitial cystitis, and the need for a multidisciplinary approach. He is instituting such methods in Taiwan. He presented studies showing that not only does lower urinary tract dysfunction impair psychosexual function; but abnormal psychological function may induce lower urinary tract dysfunction. Anxiety, depression, and panic disorder can all be associated with voiding dysfunction syndromes. Dr. Lin believes that psychological support, which may be provided by psychiatrists, social workers, consultation phone lines or patient support groups, should be included in the care of PBS/IC. Urogynecologists, physiotherapists, and dieticians should work with urologists in the treatment of these patients. Dr. Yao-Chi Chuang, Assistant Professor of Urology at the Chang Gung Memorial Hospital - Kaohsiung Medical Center, Taiwan, reviewed basic research in IC. He discussed antiproliferative factor, nerve growth factor, botulinum neurotoxin A and the potential for gene therapy.

The final portion of the meeting was devoted to a "tour of Asia", with each of the countries represented presenting their views on PBS/IC.

Shi-Liang Wu, Associate Professor of Urology, Beijing University First Hospital, China noted that IC was a "new" disease in China within the last century. The first review paper in a Chinese Journal was published in 1995. The first indigenous cases were reported in 2002. The disease is now felt to be much more common than previously thought. In several large urology centers in China, NIDDK criteria are used for diagnosis. Urodynamics and intravesical potassium testing are routinely performed. The most important therapy is hydrodistention. Intravesical GAG treatment was begun last year and initial results show a 70% improvement in symptoms. Sacral neuro-stimulation is also being used in select patients.

Dr, Willy Cecilia Cheon, Chief of Urogynecology at Queen Elizabeth Hospital (the only urogynecologist at the meeting) in Hong Kong detailed her experiences. In Hong Kong pentosan polysulfate, amitriptyline, hydroxyzine, antimuscarinics, sacral nerve stimulation, and reflexology are the standard treatments used. There have been no prevalence studies in Hong Kong. She looked at 238 consecutive patients attending her urodynamic clinic and found 28% had "IC-like" symptoms. IC is diagnosed with history, cultures, urodynamics, and bladder distention according to modified NIDDK criteria. Yukio Homma, MD, PhD, director of Urology at Japan Red Cross Medical Center, Tokyo, Japan noted that IC was under diagnosed in Japan until 5 years ago. At that time, 4 urologists familiar with the disease got together and started the "Society of Interstitial Cystitis of Japan (SICJ)". They co-authored a book with patient input entitled Interstitial Cystitis - from Epidemiology to Therapy. A patient group was formed and in 2003 an international symposium was held in Kyoto, Japan and a patient meeting followed. Yearly presentations at the Japanese Urological Association on PBS/IC have created continued interest. There is no current therapy for IC that is covered by insurance in Japan. A phase 3 study of suplatast tosilate is underway in Japan at the present time. Bae Jae Hyun, MD, PhD, Associate Professor of Urology, Korea University Hospital, Seoul, Korea described IC as an "embarrassing" disease in Korea. It was often confused with overactive bladder. Korean urologists rely on the criteria used by the NIDDK Interstitial Cystitis Database study, which is much broader than the classic NIDDK criteria. They believe that endoscopic findings of glomerulation and ulceration are not sensitive or specific enough for diagnosis. They believe that mast cell index is helpful as a pathologic marker, and that the potassium sensitivity test is positive in 63-80% of patients with the disorder. Diagnostic investigations are ongoing. Amitriptyline and pentosan polysulfate are the most commonly used treatments in Korea. Improvement is seen in 53%-73% of patients with frequency, pain, dysuria, and/or urgency. Hydrodistention studies in Korea show 26.3% of patients were asymptomatic following the procedure and 47.4% improved, however symptoms generally recurred within 3 months. Neuromodulation and bladder augmentation are used in only severe and refractory cases.

Ykun Seob Song, MD, PhD, Associate Professor Urology, Soonchunhyang Medical Center, Korea reported on data from his department. From September 2003 to August 2005, 127 patients with painful bladder syndrome were identified. After evaluation, 81 were suspected to have interstitial cystitis. Of these 81, 12 were NIDDK criteria positive. Treatment included hydrodistention, oral medication, sympathetic blockade, and sacral neuromodulation. Chong Beng Chua, Consultant Urologist and Associate Professor in the Department of Surgery, University of Malaya Medical Center, Malaysia provided insight into local experiences. Urologists in Malaysia form a small and well-trained group; all being boarded in general surgery as well as urology. While the level of healthcare availability is poor in many areas of this country, they do have 2 DaVinci robotic surgical machines, and care in the major centers is sophisticated. The urologists are busy and interstitial cystitis has not been a focus for treatment for many years. In his personal experience, there are a substantial number of patients who suffer from PBS/IC and an unmet need in Malaysia to care for these patients. Treatment is available by the few urologists in Malaysia who are well informed on this condition, but it is limited by a lack of therapeutic agents and the cost.

Hong-Jeng Yu, MD, Professor of Urology, National Taiwan University Hospital, discussed ongoing research in Taiwan. Using the O'Leary Sant questionnaire, possible IC was estimated in 0.31% of female adults aged 30 years and older. The potassium sensitivity test is used by some physicians in Taiwan to aid in diagnosis. A multimodal drug approach is often initiated for therapy. Intravesical heparin and DMSO are also commonly used for treatment.

It was clear that there is a high level of interest in painful bladder syndrome/interstitial cystitis throughout Asia. When I went to Japan in 1990 to speak about interstitial cystitis, it was essentially an unrecognized disease there, and most physicians seemed to know it only from text books. Now, the Asian urologists are on the cutting edge of basic and clinical research. This will prove to be a major benefit not only to patients in Asia, but to patients throughout the world in the years to come. The next meeting of this group is tentatively scheduled for March 2007 in Kyoto, Japan under the direction of Dr. Ueda.

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