Progress on interstitial cystitis/bladder pain syndrome: Slow but steady

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.

Dr. Hanno, a Urology Times editorial consultant, is professor of urology at the University of Pennsylvania, Philadelphia. He serves as a consultant to TARIS Biomedical, maker of the LiRIS device.