Dr. Payne asked the audience to reconsider how we think about this condition. He reviewed the historical studies of glomerulations being used to diagnose IC, and showed evidence that this method should no longer be used. He proposed that Urologists should think of Ulcerative Interstitial Cystitis as a unique disease. He described findings of patients with ulcers having abnormal bladder capacity, whereas patients with Bladder Pain Syndrome frequently have normal anesthetized bladder capacity. He also described pathological studies showing that on biopsy, there are subgroups of patients (~10%) who had parenchymal damage, urothelial denudation and edema, which correlates with the thought that around 10% of patients can be categorized as Ulcerative Interstitial Cystitis. He suggested that urologists treat Ulcerative Interstitial Cystitis using oncologic principals, starting with definitive diagnosis and staging, then treating patients to complete remission, and if not in remission, using adjuvant therapy or consolidation therapy.
He then discussed the remaining 90% of patients who can be classified as having Bladder Pain Syndrome, which importantly is a syndrome, not a disease. He described that this group of patients is heterogeneous, and that urologists need to untangle these differences to be more successful in treatment. He described the patient with true bladder pain, who has pain with bladder filling, bladder tenderness on exam, and reduced capacity. He recommended treatment with urinary analgesics, bladder instillations, and pentosan polysulfate, alongside pain management. He next described a myofascial phenotype, in which patients have trigger points outside of bladder, and pain less clearly related to the bladder. He described using additional therapy not directed at the bladder, including botulinum toxin injection and neuromodulation targeted at the muscular pain. He also described the pudendal neuropathy phenotype, with again, treatment less directed at the bladder and more focused on neuromodulation drugs, pudendal injections, surgical release, or pudendal neurostimulation. Lastly he described the systemic pain phenotype; patients who are recognizable as having multiple overlapping functional somatic syndromes. He recommended a team approach, with a focus on treatment for central sensitization, as well as on anxiety and depression.
He concluded by describing his approach to counseling patients, giving them hope for improvement and even cure.
Presented By: Christopher Payne, MD
Written By: Lindsey Cox, MD from the Medical University of South Carolina
at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA