IC/BPS research, therapies push treatment frontier

Key Points

In 2008, urology is focusing on interstitial cystitis/bladder pain syndrome (IC/BPS) in earnest, with important clinical trial results to be presented in plenary and podium sessions at the upcoming AUA annual meeting.

The presentation's title suggests a clinical trend, rapidly gaining momentum, toward recognizing the benefit of physical therapy in pelvic pain management. The study will help urologists to understand how physical therapy can help their patients cope with pelvic pain and offers further guidance as to what the second, larger ICCRN/CPCRN trial will give clinicians who need much more to offer these patients, Dr. Hanno said.

That means the review is more selective, and attendees will hear presentations that are more detailed.

Further developments in IC/BPS

In the Sunday podium session, for example, urologists will hear about concrete evidence of the benefit of intravesical anesthetics, a new kind of in-office cystoscopy that might visualize Hunner's lesions without hydrodistention, a new approach that might yield a diagnostic test for IC, and gene therapy that could help IC bladder cells produce their own opioid.

The new type of flexible cystoscope being developed in Japan has narrow-band imaging that may reveal Hunner's lesions and areas of angiogenesis on the bladder wall without the need for hydrodistention. That could take this helpful screening tool into the office with local anesthesia.

"A lot of patients don't tolerate local cystoscopy," noted Dr. Hanno, "but a lot of them can as long as you don't overstretch the bladder."

Urologists can perform the traditional cystoscopy with hydrodistention under anesthesia with appropriate postoperative pain control for those who won't be able to tolerate the procedure, but for those who can, the new technology has potential to spare some patients pain and reduce costs.

Intravesical instillation of anesthetics, especially alkalinized lidocaine and other helpful drugs, is something many urologists do already for their IC/BPS patients that can ease bladder pain. Some new studies help bolster those therapies with urodynamic and placebo control evidence.

A potential commercial alkalinized lidocaine preparation was studied in the placebo-controlled trial. Alkalinization is thought to allow lidocaine to be absorbed into bladder urothelium, enhancing its effect.

Dr. Hanno noted that urologists already use sodium bicarbonate with lidocaine to make up instillation solutions easily and inexpensively. Typically, other drugs, such as heparin, are added as well. In that case, urologists should make sure they have disposed of their entire stock of recalled heparin and that they have their patients who have been doing at-home instillations do so also. Anesthetic instillations aren't a final answer to bladder pain, "but in someone who is having a lot of bladder pain, it may buy you some time," Dr. Hanno said.