UroToday - Beyond the Abstract - Treatment of Bladder Pain Syndrome/Interstitial Cystitis 2008: Can We Make Evidence-Based Decisions?

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Beyond the Abstract - Treatment of Bladder Pain Syndrome/Interstitial Cystitis 2008: Can We Make Evidence-Based Decisions?

Tuesday, 10 June 2008

BERKELEY, CA (UroToday.com) - As the definition of Interstitial cystitis (IC) has become wider and wider, reflected in dramatically increasing prevalence figures, it has become more rather than less difficult to grasp this symptom complex - from an etiologic/pathogenetic as well as therapeutic point of view. No doubt are we dealing with a heterogeneous and poorly defined spectrum of disorders, and trial and error remains the leading treatment principle. Few methods reach a high degree of recommendation.

What can be learned from the present situation? This survey seems to support various hypothesis of pathogentic mechanisms like epithelial dysfunction, supported by good evidence for oral and intravesical pentosan polysulfate sodium treatment; neural dysfunction, supported by results of amitriptyline and hydroxyzine treatment; and immunologic abnormalities, supported by good responses to cyclosporine A and again support for hydroxyzine. It has to be assumed that methods as different as those are not useful in all patients, but rather in more or less specific situations. By very carefully identifying characteristics of patients responding to various principles, observations can be made giving clues to distinctive biological marks that may help when trying to design rational treatment for various categories.

Already at this stage, as emphasized before, the classic form of IC (with Hunner lesions) stands out as a well defined disease that deserves special attention, but there are certainly other distinctive categories to be identified and described. When we have learned better why and what we are doing, an improved situation as to evidence will follow.

Written by
Magnus Fall, MD, PhD, as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

Treatment of Bladder Pain Syndrome/Interstitial Cystitis 2008: Can We Make Evidence-Based Decisions? - Abstract

UroToday.com IC/PBS/BPS Section

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Reader Comments

Interstitial Cystitis Network Founder
Written by This email address is being protected from spam bots, you need Javascript enabled to view it on 2008-06-11 23:55:10

Dr. Fall captures this dilemma perfectly. IC/PBS/BPS is clearly a heterogenous set of disorders... from patients struggling with severe bladder wall ulceration to patients who normal cystoscopic findings who struggle with frequency/urgency/pain... to patients who struggle pelvic floor tension and, perhaps, even pudendal neuralgia. Perhaps instead of changing nomenclature (when the condition itself is so poorly understood), research should focus more on trying to identify clear subsets. The presence of pelvic floor dysfunction, for example, atleast identifies a viable treatment modality in the form of muscle relaxants and physical therapy.

I, for one, would love to see consensus on the treatment of those patients with the most severe form of IC. Can we atleast agree that the use of coatings, for example, are perhaps a waste of time in contrast to laser therapy and/or fulguration which can atleast close the wound? I'd love to see a round table discussion of international experts on the treatment of Hunner's Ulcers specifically.

Thank you Dr. Fall

Jill O.

chairman IPBF
Written by This email address is being protected from spam bots, you need Javascript enabled to view it on 2008-06-11 06:25:50

I totally support what Magnus Fall says here.

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