Articles in this issue of Urology Times highlight two of the more interesting abstracts on interstitial cystitis/bladder pain syndrome (IC/BPS) presented at the 2012 AUA annual meeting in Atlanta. They illustrate the relentless progress being made in the efforts to improve the lives of patients with this difficult-to-treat syndrome.
Ten years ago, as the Interstitial Cystitis Collaborative Research Network was getting under way, Mary Pat FitzGerald, MD, suggested a randomized controlled trial of myofascial physical therapy as a primary treatment intervention. Investigators initially showed little enthusiasm for this, but she persuaded the group to undertake a pilot trial (J Urol 2009; 182:570-80). Success in the pilot led to a large, multicenter RCT that was perhaps one of the most successful IC/BPS treatment trials ever undertaken (J Urol 2012; 187:2113-8). Why should this therapy be so effective?
A. Lenore Ackerman, MD, and colleagues at UCLA examined pelvic MRI studies in 15 IC/BPS patients and 15 controls. Various measurements showed the effects of hypertonicity on the pelvic floor in the IC/BPS group, reflecting the neuromuscular component of the painful symptoms experienced by many IC/BPS patients. Whether the neuromuscular component is primary or secondary to pain initially generated in the bladder is not yet known. The neuromuscular component (pelvic floor dysfunction) may well differ among patient groups, providing yet another opportunity for phenotyping this syndrome and directing treatments to patient groups most likely to benefit.
An uncontrolled phase Ib trial of an intravesical lidocaine-delivery device called LiRIS was reported by J. Curtis Nickel, MD. Results in the 18 patients who had the device inserted into the bladder and removed 2 weeks later were extremely impressive. Symptoms seemed to improve not only during the 2 weeks of slow-release lidocaine, but also for several weeks after the device had been removed. Resolution of Hunner's lesions was noted in six of seven patients. As with all IC/BPS treatments, we will have to await results of much larger and placebo-controlled trials before drawing any conclusions about the ultimate value of this therapy. As noted in the article, a phase II trial is ongoing, although this study has been temporarily suspended due to lack of efficacy in an interim analysis. Regardless of the ultimate results using intravesical lidocaine for IC/BPS, one can speculate that this novel drug delivery system might have potential for use in IC/BPS, overactive bladder, and/or urothelial malignancy.