KYOTO, JAPAN (UroToday.com) - The second ICICJ took place in Kyoto in March 2007, 4 years after the initial meeting.

The meeting was designed to further the international discussions regarding nomenclature, definition, and diagnostic algorithm and thereby foster more international cooperation. The proceedings are scheduled to be published later this year in the International Journal of Urology as a supplement, similar to the way the proceedings of the initial ICICJ were published.

Vicki Ratner and Juergen Hensen, representing patient organizations in the US and Germany, began the meeting with impassioned arguments to keep the designation "IC", followed by the designation "PBS" for painful bladder syndrome. Their arguments are detailed in the report of the ARHP meeting in February, and results of that meeting were given in Kyoto. They believe that only when a definite etiology of IC has been established would there be scientifically based justification for a name change.

Dr. Ming-Huei Lee showed an inspirational video about his founding of TICA, the Taiwan Interstitial Cystitis Association, and the wonderful work it is doing. It is a rare example of a magnificent collaboration between physicians and patients, inside and outside of the health care system, to attempt to treat the whole person rather than the disease. His video would help those interested in establishing similar associations in their countries.

Dr. Yukio Homma from the Japan Red Cross Medical Center, and the leader of the Society of Interstitial Cystitis of Japan, gave a riveting talk that reviewed the current status of IC in Japan. He sees confusion in that IC can be viewed as both a symptom syndrome and as a distinct disease. He would like to refer to the syndrome of increased sensation, frequency, urgency, with or without bladder pain as "hypersensitive bladder syndrome", HSB. The term "interstitial cystitis" would be used to refer to patients with a particular histology on bladder biopsy. He noted that bladder pain is no longer considered a rarity in Japan, and that a recent epidemiology survey indicated a prevalence of 1%.

Dr. Jeong Gu Lee of Korea University Medical Center in Seoul discussed Korean aspects of IC. In Korea, confusion abounds with regard to IC. The first case report appeared only in 1972. The definition of the International Continence Society for Painful Bladder Syndrome is widely accepted and applied in Korea. Amitriptyline and pentosanpolysulfate are the most widely used treatments for IC in Korea. He reported that amitriptyline was compared to propiverine hydrochloride and diazepam. Frequency and pain were significantly improved with amitriptyline compared to alternative therapies, with improvement rates of 73% and 68% respectively. Early experience with the Stoller afferent nerve stimulator is promising, and Interstim was effective in 70% of patients implanted, with urgency responding more than pain.

Alex Lin, president of the Taiwan Continence Society reviewed the current status of PBS/IC in Taiwan. The syndrome is often considered a psychological problem and not a true disease. Epidemiologically, Dr. Yu in the National Taiwan University found IC symptoms affecting 2-600 per 100,000 women in Taiwan when using the O'Leary Sant questionnaire to identify the syndrome. This prevalence of 300/100,000 on average is similar to the incidence in Finland and Austria when using similar definitions. Most doctors in Taiwan make the diagnosis based on the classic NIDDK criteria. As patients hesitate to undergo cystoscopy under anesthesia, under-diagnosis may result. Pentosanpolysulfate seems to be the most popular oral medication in Taiwan. Bladder instillation is not popular. Dr. Lin discussed his psychological study which demonstrates a high prevalence of depression and anxiety symptoms in patients with IC, affecting over 40%.

Dr. Nagendra Mishra discussed the current situation in India. He discussed the IC symposium held at the Indian Urologic Congress in Patna in February. A survey of 77 urologists revealed that hydrodistention and oral therapy are applied to 60% of patients. They were surveyed on nomenclature preference. Interestingly, of 77 urologists, only 22 preferred the IC name and the rest divided between Painful Bladder Syndrome and PBS/IC.

Dr. Ted Arnold focused on the perspective from Australia and New Zealand. He found confusion in the minds of many specialists in definition of chronic pelvic pain syndrome and in its diagnosis. Management is empirical and divided among urologists, gynecologists, and even colorectal surgeons. Expected outcomes of interventions are conjectural. Much work remains to be done, he concluded.

Dr. Hanno and Dr. Nordling reviewed name, definition, and evaluation from the American and European points of view, stimulating a very animated discussion with the patient representatives and Asian urologists. This was followed by a very elegant presentation by Dr. Homma about HSB (Hypersensitive Bladder). He noted the confusion with regard to overactive bladder and painful bladder syndrome, and specifically the problem inherent in using the International Continence Society definition of urgency (a compelling urge to void that is difficult to defer). All overactive bladder patients have urgency, but most IC patients complain of "urgency" as well. The two forms of "urgency" are not alike as the former is for fear of leakage and the latter is due to pain or discomfort. He states that "IC" depends on symptoms and bladder pathology and is a disease. Painful bladder is a syndrome (PBS) with no identifying pathology. He believes that painful bladder syndrome and IC and both fall within the HSB boundaries which include some patients with overactive bladder - dry.

Several superb abstracts regarding basic science and clinical practice around the world were displayed in the poster session. Dr. Yoshimura summarized basic science research into etiology, concluding that although the etiology of PBS/IC is still not clarified, several potential pathologic processes including urothelial dysfunction, neurogenic inflammation, and neuroplasticity of sensory pathways have been proposed. No one process has been identified in every patient. It is likely that PBS/IC may have multiple etiologies, all of which result in similar clinical manifestations. Many of the pathologic processes may act in concert to produce the clinical features of PBS/IC.

It is not possible in this brief report to go over each of the presentations over the 3 days of the meeting. Suffice it to say that Drs. Mayer and Tomoe moderated the symptom section, Dr. Nordling and Takei led discussions on cystoscopy and Urodynamics, and Dr. Rosamilia and Dr. Ueda led a fascinating discussion of pathology. The meeting continued with a section on treatment. An acupuncture study reported by Dr. Hisashi Honjo and colleagues detailed results in 10 patients with significant symptoms who demonstrated improvement in frequency, maximum voided volume, and vas pain questionnaire which increased over the course of 12 treatments. A sham study is certainly warranted.

Dr. Leroy Nyberg from the National Institutes of Health concluded the meeting with a new paradigm that the NIDDK may determine as the foundation of future research studies, considering Painful Bladder Syndrome / Interstitial Cystitis /Bladder Pain Syndrome as a bladder manifestation of a more global disorder that can result in one of a number of pain or inflammatory syndromes; witness the large number of disorders found to be associated with BPS/IC.

Dr. Ueda hopes to convene the 3'rd ICICJ in 4 years.

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