Diagnosis/Assessment

• New IC Urine Marker Identified
  Fukui Y, Kato M, Inoue Y, Matsubara A, Itoh K. A metabonomic approach identifies human urinary phenylacetylglutamine as a novel marker of interstitial cystitis. J Chromatogr B Analyt Technol Biomed Life Sci. 2009 Sep 26. [Epub ahead of print]
  Japanese biotechnologists have identified a potential urine marker for IC with ultra-performance liquid chromatography-mass spectrometry. They tested the urine of 10 IC patients, 10 bacterial cystitis patients, and 10 healthy volunteers. The marker that showed up in IC patients’ urine at high levels compared with the others was phenylacetylglutamine (which is measured relative to creatinine). Interestingly, the levels in the urine of patients with mild and moderate IC were higher than levels in urine of those with severe IC. The authors believe these results establish this as a new IC marker, which could help diagnose IC early.

• New Questionnaire Useful for both IC and CP/CPPS
  Clemens JQ, Calhoun EA, Litwin MS, McNaughton-Collins M, Kusek JW, Crowley EM, Landis JR; Urologic Pelvic Pain Collaborative Research Network. Validation of a Modified National Institutes of Health Chronic Prostatitis Symptom Index to Assess Genitourinary Pain in Both Men and Women. Urology. 2009 Oct 1. [Epub ahead of print]
  Because IC and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) have similarities and are often being studied together, these researchers developed and tested a questionnaire, called the Genitourinary Pain Index (GUPI), that would be useful for both conditions in both sexes. They modified and added questions to the NIH Chronic Prostatitis Symptom Index and tested it on 1,653 men and 1,403 women in a managed care setting and also tested it in 47 men and women who completed the recent trial of pelvic floor physical therapy. The GUPI helped discriminate between men with CP/CPPS or IC and those with other urinary conditions or with no urinary conditions. It also discriminated well between women with IC and women with incontinence or neither of those diagnoses. It correlated well with the O’Leary-Sant Interstitial Cystitis Symptom and Problem Index. The GUPI was very sensitive to change in the patients’ conditions, and a reduction of seven points showed who responded to treatment. The researchers believe they now have a valid, reliable, and responsive measurement tool for assessing the severity of symptoms in both men and women with genitourinary pain complaints.

• Symptoms, Pain Correlate with Bladder Volume Urodynamic Tests
  Sastry DN, Hunter KM, Whitmore KE. Urodynamic testing and interstitial cystitis/painful bladder syndrome. Int Urogynecol J Pelvic Floor Dysfunct. 2009 Oct 16. [Epub ahead of print]
  Some urodynamic tests showing low urine volume and more pain as the bladder fills correlate well with pain scores and higher scores on the O’Leary-Sant Symptom Index. For this reason, these authors concluded that urodynamics may be a useful adjunctive test for IC patients. Routine use of urodynamics hasn’t been recommended in IC by most IC experts, however, so be sure to discuss the pros and cons of testing with your doctor.

• In-office Hydrodistention after Lidocaine Instillation Looks Safe
  Aihara K, Hirayama A, Tanaka N, Fujimoto K, Yoshida K, Hirao Y. Hydrodistension under local anesthesia for patients with suspected painful bladder syndrome/interstitial cystitis: Safety, diagnostic potential and therapeutic efficacy. Int J Urol. 2009 Oct 11. [Epub ahead of print]
  These Japanese urologists did cystoscopy and hydrodistention after lidocaine instillation in 36 patients with suspected IC to check safety, usefulness in diagnosis, and therapeutic effects of this approach. Patients had 10 mL of 4 percent lidocaine instilled and then underwent cystoscopy with hydrodistention 10 minutes later. No patients were admitted to the hospital because of adverse effects. Of the 30 patients, 23 had glomerulations and 2 had Hunner’s ulcers. After one month, 21 still had relief. Patients who had somewhat more than the average amount of saline instilled for hydrodistention (450 mL) seemed to get longer relief. Using a local anesthetic means that the procedure would not have to be done in the hospital. This approach is not usually used in the United States, where patients usually go to the hospital and have this done under general anesthesia. If you are considering cystoscopy and hydrodistention under local anesthesia, be sure to discuss the pros and cons with your doctor.

• It Isn’t Always IC—Urologists Cautioned To Be Thoughtful, Thorough
  Fletcher SG, Zimmern PE. Differential diagnosis of chronic pelvic pain in women: the urologist's approach. Nat Rev Urol. 2009 Sep 1. [Epub ahead of print]
  There are many causes of chronic pelvic pain in women, and there are many different causes of IC-like symptoms, so diagnosis needs to be done carefully and thoroughly. This article reflects the message of Philippe Zimmern, MD’s, plenary session presentation at the 2008 annual meeting of the American Urological Association, in which he discussed many examples of patients who had sometimes severe symptoms diagnosed as IC which were, in fact, produced by other conditions that could have been treated more easily. He pointed out that many other urologic conditions, such as overactive bladder, urinary tract infection, urethral diverticulum (outpouching), masses near the urethra (such as Skene gland cyst or abscess), and even urethral stricture disease produce symptoms similar to IC. He demonstrates how taking a multidisciplinary diagnostic approach and working step by step with an evidence-based thought process can successfully narrow down the cause of the symptoms and lead to successful treatment.

• Urine Protein Could Be Marker of IC and IC Symptom Severity
  Makino T, Kawashima H, Konishi H, Nakatani T, Kiyama H. Elevated Urinary Levels and Urothelial Expression of Hepatocarcinoma-Intestine-pancreas/Pancreatitis-associated Protein in Patients With Interstitial Cystitis. Urology. 2009 Jul 29. [Epub ahead of print]
  Japanese researchers have found a urine protein that IC patients have much more of than people with healthy bladders.  Moreover, levels of the protein correlate with the severity of symptoms.  The protein is known as hepatocarcinoma-intestine-pancreas/pancreas-associated protein or HIP/PAP averaged 13.67 pg/mL of urine in IC patients compared with 1.86 pg/mL in healthy people.  It was also expressed in the bladder lining of 88 percent of patients with IC (15 out of 17) compared with 6 percent of healthy people.  The levels in urine in IC patients correlated with frequency, bladder pain, and urine volume, with higher levels in those with more frequency and pain and lower levels in those with larger voided volumes of urine.  This protein may play a role in the IC disease process, suggested the researchers.

• Urgency Is Different in IC
  Hanno PM, Chapple CR, Cardozo LD. Bladder pain syndrome/interstitial cystitis: a sense of urgency. World J Urol. 2009 Jun 24. [Epub ahead of print]
  Three symptoms -- bladder pain, urinary frequency, and urgency -- have been used to define IC and painful bladder syndrome or bladder pain syndrome.  Urgency in the condition is different, however, from the urgency of overactive bladder syndrome.  It isn’t clear exactly how to define IC urgency, and differences in the other primary symptoms likely drive that difference in IC urgency, wrote the authors.  The authors note that research into the pathophysiology of urgency and underlying disease processes will yield better ways to diagnose and treat the condition.

• Testing Touch Sensitivity with Pelvic Pain
  Jarrell J. Demonstration of cutaneous allodynia in association with chronic pelvic pain. J Vis Exp. 2009 Jun 23;(28). pii: 1232. doi: 10.3791/1232.
  With pelvic pain, related areas on the skin can get sensitive to touch.  An easy test can show it and may help guide treatment.  Because nerves that serve pelvic organs also come from the same roots as nerves that serve specific areas of the body wall, skin in those areas can become hypersensitive to touch when someone has a pelvic pain condition.  That sensitivity can persist even after the internal condition is treated.  Touching the related area with a cotton-tipped applicator can show a healthcare provider that the nervous system may have become sensitized by the pelvic pain, indicating further invasive treatment, such as surgery, may not be needed to treat the pain, said the author.

• Pelvic Pain Alters Posture
  Montenegro ML, Mateus-Vasconcelos EC, Rosa E Silva JC, Candido Dos Reis FJ, Nogueira AA, Poli Neto OB. Postural changes in women with chronic pelvic pain: a case control study. BMC Musculoskelet Disord. 2009 Jul 7;10(1):82. [Epub ahead of print]
  Women with pelvic pain carry themselves differently -- or at least a third do.  These gynecologists and anatomists looked at the posture of 108 women who had chronic pelvic pain, comparing it with the posture of 48 healthy women.  (The researchers defined chronic pelvic pain as lower abdominal pain lasting at least six months, occurring continuously or intermittently and not associated exclusively with menstruation or intercourse.)  Although posture in the women with pelvic pain varied, some of the more typical changes were those in the neck (cervical spine) and shoulder blades (scapulae).  Because posture can contribute to pelvic pain, the authors noted that including posture in a detailed assessment could help bring better treatment for women with chronic pelvic pain.

• New Serum Marker May Diagnose IC
  Rubio-Diaz DE, Pozza ME, Dimitrakov J, Gilleran JP, Giusti MM, Stella JL, Rodriguez-Saona LE, Buffington CA. A candidate serum biomarker for bladder pain syndrome/interstitial cystitis. Analyst. 2009 Jun;134(6):1133-7. Epub 2009 Apr 16.
  A signature in serum seen through an infrared microscope may diagnose IC.  The preliminary study of the technique, which we covered in our reports from the 2008 American Urological Association annual meeting, has now been published.  The researchers looked at the infrared spectra of serum from 29 humans and 34 cats to differentiate serum from humans and cats with IC from those who had no IC.  The technique correctly predicted the condition of 100 percent of the subjects.  Further analysis of cat samples pointed to a difference in blood concentrations of tryptophan and its metabolic products between healthy and affected cats.  The ICA Pilot Research Program funded this study.

• Nerve Growth Factor Proves To Be Good Pain Marker
  Liu HT, Tyagi P, Chancellor MB, Kuo HC. Urinary nerve growth factor level is increased in patients with interstitial cystitis/bladder pain syndrome and decreased in responders to treatment. BJU Int. 2009 Jun 12. [Epub ahead of print]
  Levels of nerve growth factor (NGF) in IC patients’ bladders fluctuate with the pain level, so NGF might make a useful marker of the severity of IC.  It’s been known that NGF levels are high in IC patients’ urine compared with that of healthy patients.  Now, these researchers have looked at how the levels change with treatment.  In the 122 patients, NGF levels (in relation to creatinine levels, which makes measurements more comparable) were higher than levels in healthy subjects, but IC patients’ levels didn’t correlate with pain scores or bladder capacity at the time of diagnosis or to maximum bladder capacity.  However, patients who felt better after treatment and had pain scores improve by two or more points had significantly lower NGF levels than those who didn’t respond or had an improvement in pain of less that two points.  That means that NGF may be useful for tracking improvement.

• Classification System Could Improve IC Treatment
  Nickel JC, Shoskes D, Irvine-Bird K. Clinical phenotyping of women with interstitial cystitis/painful bladder syndrome: a key to classification and potentially improved management. J Urol. 2009 Jul;182(1):155-60. Epub 2009 May 17.
  A new classification system applied to IC shows that patients who have symptoms longer have more problems, but knowing which ones could improve treatment.  This system, called UPOINT and detailed in an interview with its originator in the Spring 2009 issue of the ICA Update, helps assess whether patients have symptoms related to six categories: urinary, psychosocial, organ-specific, infection, neurological/systemic (such as fibromyalgia), and tenderness.  In the 100 cases classified with the system, the percentages positive for each part were: urinary 100 percent, psychosocial 34 percent, organ specific 96 percent, infection 38 percent, neurological/systemic 45 percent, and tenderness 48 percent.  All patients were positive for at least two domains: 13 percent had two, 35 percent had three, 34 percent had four, 13 percent had five, and 5 percent had six.  Patients who were positive for more domains had their symptoms for longer and had more IC and pain symptoms.  Domains that related to symptoms outside of the bladder (psychosocial, neurological, tenderness) correlated with increased symptoms.

• IC/“Bladder Pain Syndrome” Subgroups Are Not So Different
  Butrick CW, Sanford D, Hou Q, Mahnken JD. Chronic pelvic pain syndromes: clinical, urodynamic, and urothelial observations. Int Urogynecol J Pelvic Floor Dysfunct. 2009 May 21. [Epub ahead of print]
  No matter what the major complaint, patients with IC/bladder pain syndrome (BPS) had similar problems and responded similarly to therapy.  Interestingly, 5 to 10 percent of patients who had stress incontinence, urge incontinence, or prolapse also had IC/BPS.  The researchers divided 408 patients into subgroups based on their main complaint: IC/BPS, chronic pelvic pain, vulvodynia/painful intercourse, or “other.”  However, all four groups had similar levels of urinary dysfunction, painful intercourse, pain/urgency/frequency (PUF) scores, and potassium sensitivity test results.  In addition, instillation of anesthetic cocktails into the bladder benefited all the groups.

• Multichannel Urodynamics Can Be Painful
  Segev Y, Rosen T, Auslender R, Dain L, Abramov Y. How painful is multichannel urodynamic testing? Int Urogynecol J Pelvic Floor Dysfunct. 2009 Apr 24. [Epub ahead of print]
  Although many IC experts believe that urodynamic studies are not very helpful in IC, they are sometimes performed.  This study indicates that it can be painful, which may add a reason to avoid it in IC patients.  The investigators looked at records of women with lower urinary tract symptoms who underwent multichannel urodynamic testing.  The patients’ pain increased mildly but significantly during the test and decreased afterward.  The degree of pain did not correlate with various clinical and pelvic floor characteristics.

• Differences between IC/PBS and Overactive Bladder Show in Urodynamics
  Kim SH, Kim TB, Kim SW, Oh SJ. Urodynamic Findings of the Painful Bladder Syndrome/Interstitial Cystitis: A Comparison With Idiopathic Overactive Bladder. J Urol. 2009 Apr 15. [Epub ahead of print]
  These urologists did fluorourodynamic studies (urodynamics using x-ray) of 40 women with painful PBS/IC and 78 women with idiopathic (no cause understood) overactive bladder.  There were significant differences between the groups in terms of the maximum flow rate, voided volume, maximal urethral closing pressure, maximal urethral pressure, the volume at which the women felt the desire to void, the maximum bladder capacity, and bladder compliance (ability to stretch).  None of the IC/PBS patients had involuntary detrusor contractions (the unexpected “gotta go” spasms).  There was also no difference in the maximum bladder pressure for voiding between the groups.  Although the authors suggested that urodynamics might be used to confirm a diagnosis of IC/PBS, the differences that this study showed are usually apparent in IC/PBS patients’ history -- they have small bladder capacities, feel the urge to urinate with only small volumes of urine, and have bladders that cannot hold very much.

• Some Patients, Especially with Worse Disease, Have Bladder Outlet Obstruction
  Cameron AP, Gajewski JB. Bladder outlet obstruction in painful bladder syndrome/interstitial cystitis. Neurourol Urodyn. 2009 Mar 19. [Epub ahead of print]
  Some patients with IC/PBS have obstruction at the base of the bladder.  That causes symptoms such as slow stream, dribbling, and straining.  These urologists looked at urodynamics results and patients’ charts to see whether patients had bladder outlet obstruction and whether it was more common with worse disease.  Of 231 women, 38 had Hunner’s ulcers.  Those with Hunner’s ulcers had much smaller bladder capacity than those who didn’t.  Of the 231 women, 111 (48 percent) had urodynamic evidence of bladder outlet obstruction.  Their maximum bladder capacity was significantly lower than the capacity in those who didn’t have obstruction.  Maximum flow in those who had Hunner’s ulcers was lower than in those who didn’t have ulcers.

• Canadian Group Makes Recommendations for IC Diagnosis
  Carr LK, Corcos J, Nickel JC, Teichman J. Diagnosis of interstitial cystitis. June 2007. Can Urol Assoc J. 2009 Feb;3(1):81-6.
  Based on a consensus conference in 2007, these Canadian urologists developed guidelines for IC diagnosis.  Their guidance on history taking and physical examination notes that patients with early disease may not describe pain but rather pressure or an uncomfortable sensation and that a history of urinary tract infection is common.  A frequency and volume diary or chart can help distinguish simple frequency from the frequency with small urine volumes typical of IC.  Pelvic exams for women and digital rectal exams for men are called essential, and the authors recommend that doctors look for bladder distension, hernias, signs of nerve entrapment, and trigger points in the abdomen, prostate, and pelvic floor muscles.  They also recommend using symptom scales to help make the diagnosis and follow patients’ progress.  The authors consider the potassium test and cystoscopy done under local anesthesia to be optional, noting that the potassium test is not recommended as a standard evaluation and that cystoscopy without hydrodistention is useful only for ruling out cancer.  Hydrodistention under general anesthesia is also called optional.  The authors did not recommended biopsy and urodynamics.  This paper is available free-of-charge online.

• Experts Outline Current Thinking on Name, Definition, Diagnosis
  Hanno P, Dmochowski R. Status of international consensus on interstitial cystitis/bladder pain syndrome/painful bladder syndrome: 2008 snapshot. Neurourol Urodyn. 2009 Mar 3. [Epub ahead of print]
  The Society for Urodynamics and Female Urology brought together IC/painful bladder syndrome (PBS) experts from Europe, Asia, and the United States to get a snapshot of current thinking on the name and definition of the syndrome and how do evaluate it.  The most appropriate name remains a matter of contention.  The authors noted that, even so, many agreed on this “definition”: an unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of more than 6 weeks duration, in the absence of infection or other identifiable causes.  The world seems to be moving toward agreement that a doctor can make a diagnosis based on history and physical examination, reserving invasive tests for more complicated cases, although this view is more common in the United States and Asia than in Europe.

• Multidisciplinary Approach Emphasized for Chronic Pelvic Pain
  Vincent K. Chronic pelvic pain in women. Postgrad Med J. 2009 Jan;85(999):24-9.
  This article in a general medical journal emphasizes that pelvic pain conditions frequently overlap medical specialties because of nerve and physical connections between pelvic organs.  That overlap can lead to delays and often to inadequate treatment.  The author urged readers to do careful histories and examinations and argued for a multidisciplinary approach to treatment.

• Quality of Life Tracks Treatment Response
  Sairanen J, Leppilahti M, Tammela TL, Paananen I, Aaltomaa S, Taari K, Ruutu M. Evaluation of health-related quality of life in patients with painful bladder syndrome/interstitial cystitis and the impact of four treatments on it. Scand J Urol Nephrol. 2009 Jan 9:1-8. [Epub ahead of print]
  Today, most researchers use a measure called the global response assessment (GRA) to gauge how patients do with treatment.  It simply asks if you are better, the same, or worse.  As you would expect, quality of life would improve along with getting better, and now that's been tested with IC treatment against the GRA.  The study found that quality of life generally improves along with improvement in IC symptoms.  That means that a standard questionnaire on quality of life, which measures a number of aspects, might also be used to assess how good a treatment might be.  These investigators used both scales in two studies: one of treatment with bladder instillations of DMSO and bacille Calmette-Guérin (BCG) and the other with cyclosporine A and pentosan polysulfate (Elmiron).  Patients who responded to treatment had improved quality of life.  Cyclosporine A had more effect on emotional well-being, social functioning, activity limitation days, pain, and physical capacity than pentosan polysulfate.  Interestingly, although more patients responded to DMSO than BCG treatment according to the GRA, quality of life results were equal after those treatments.
  
  
• Better Questionnaires Could Give Better Answers in Treatment Studies
  Payne C, Allee T. Goal achievement provides new insights into interstitial cystitis/painful bladder syndrome symptoms and outcomes. Neurourol Urodyn. 2009;28(1):13-7.
  How well a treatment does for IC patients is usually measured with a global response assessment scale, on which patients simply rate whether they are better, the same, or worse.  But these investigators are looking for something more specific, similar to what has been used in chronic pain, rheumatoid arthritis, and incontinence.  The questions are developed using surveys and focus groups of patients, who convey what their goals are for treatment and whether they get achieved, a method called "goal assessment scaling" (GAS).  Of IC/PBS patients, about 4 percent had pain goals, whereas 56 percent had frequency and/or nocturia goals.  The work with patient focus groups also showed that urgency is separate from pain or frequency, and that any of these may take priority for a patient.  The focus groups defined urgency as "the need to urinate due to an unpleasant sensation that prevents attention to any other task."  GAS holds promise, said the authors, for addressing individuality in a standardized format.  A new GAS questionnaire for assessing treatments is being used for the first time in a multicenter, randomized controlled trial.  The authors also suggest that questionnaires about urgency in IC/PBS clarify the definition to be more applicable to the condition.
  
  
• Tarlov Cyst Surgery Resolves Bladder Symptoms
  Ruibal Moldes M, Sánchez Rodríguez-Losada J, López García D, Casas Agudo V, Janeiro País JM, González Martín M. Tarlov cyst and symptomatic bladder disfuction. [Article in Spanish] Actas Urol Esp. 2008 Nov-Dec;32(10):1035-6.
  ICA Update readers know about a case of an IC patient who had this type of fluid cyst on a sacral nerve root that apparently caused IC symptoms and pain.  These cysts are very uncommon, but when they affect the sacral nerve, which serves the bladder, they may cause symptoms that can be comparable to IC.  This article published in a medical journal is about a somewhat similar case.  The authors explain that the cysts are uncommon and usually cause pain and referred pain, such as down the leg.  But in this case of a 53-year-old woman, the cyst also caused what they termed "frequency and urgency syndrome." After the woman had the cyst operated on, her symptoms disappeared.
  
  
• New Cystoscope Imaging Detects Ulcers, Glomerulations without Hydrodistention
  Ueda T, Nakagawa M, Okamura M, Tanoue H, Yoshida H, Yoshimura N. New cystoscopic diagnosis for interstitial cystitis/painful bladder syndrome using narrow-band imaging system. Int J Urol. 2008 Nov 13. [Epub ahead of print]
  A new cystoscopic imaging system can detect glomerulations or Hunner's ulcers without hydrodistention.  The first study of this system in IC patients, which the ICA covered in its reports from the American Urological Association meeting in May and in the ICA Update, has now been published.  The patients in the study with suspected IC (49 women and 3 men) first had conventional cystoscopy under spinal anesthesia.  Then, they underwent cystoscopy with the new narrow-band imaging system.  All the ulcers seen with conventional cystoscopy (37 patients had them) were confirmed with the new system.  The blood vessel-rich areas seen with the system in 13 patients showed hemorrhages and glomerulations when these patients underwent hydrodistention.  The authors concluded this was a practical system to help diagnose IC/PBS.  As many IC patients know, conventional cystoscopy can be very painful, but this system may be useful for those who can withstand it when lidocaine is put into the urethra and they undergo light sedation or spinal anesthesia, like these patients.
  
  
• Newer IC/PBS Definition Still Misses Patients
  Mouracade P, Lang H, Jacqmin D, Saussine C. Using the interstitial cystitis new diagnostic criteria in daily practice: About 156 patients. Prog Urol. 2008 Nov;18(10):674-7. Epub 2008 Jul 1.
  These French urologists tested the 2005 definition of IC/PBS from the European Society for the Study of Interstitial cystitis (ESSIC) with 156 patients diagnosed with the condition at their institution.  They relied on history and confirmed the diagnosis based on standard questionnaires, voiding diaries, cystoscopy and hydrodistention, and excluding other diseases.  The 2005 definition identified only 74 percent of the patients as having IC.  Among these patients the ration of females to males was 8:1.  The patients had symptoms for a median of 7.3 years before they got their diagnosis.  Pain was the most common symptom -- 100 percent had it -- followed by frequency (82 percent) and nighttime voiding (62 percent).  The most common sites of pain were suprapubic (80 percent), perineal (70 percent), and genital (40 percent); 55 percent had a burning sensation.  Only three patients had Hunner's ulcers, but 88 percent had glomerulations.
  
  
• Questionnaire Developed for Multiple Pelvic Floor Problems
  Baessler K, O'Neill SM, Maher CF, Battistutta D. Australian pelvic floor questionnaire: a validated interviewer-administered pelvic floor questionnaire for routine clinic and research. Int Urogynecol J Pelvic Floor Dysfunct. 2008 Oct 29. [Epub ahead of print]
  These investigators designed and tested a pelvic floor questionnaire to assess pelvic floor problems related to bladder, bowel, sexual function, and pelvic organ prolapse, and to assess severity and bother of these conditions and the patient's quality of life related to the condition.  The scores were different among women at a urogynecology clinic when compared with women in the community.  Scores on various parts of this questionnaire correlated with already established questionnaires specific to the different functions.  Scores held up on retesting, a measure of the validity of a questionnaire.
  
  
• German Urologist Calls for Name, Definition Change
  van Ophoven A. From end-organ disease to a classifiable bladder pain syndrome: Paradigm shift in the understanding of urological pain syndromes exemplified by the condition currently called interstitial cystitis. Urologe A. 2008 Oct 24. [Epub ahead of print]
  This author makes an argument for using the recent ESSIC definition of IC and the change of name to bladder pain syndrome, or BPS.  The author suggests that therapy be aimed at both the bladder lining and the central nervous system, such as with a combination of tricyclic antidepressants with instillation therapy.
  
  
• Cytokines Show Potential as Urine Markers of IC
  Smaldone MC, Vodovotz Y, Tyagi V, Barclay D, Philips BJ, Yoshimura N, Chancellor MB, Tyagi P. Multiplex Analysis of Urinary Cytokine Levels in Rat Model of Cyclophosphamide-induced Cystitis. Urology. 2008 Oct 8. [Epub ahead of print]
  Because urine is so accessible for testing, the University of Pittsburgh researchers are looking for potential urine markers of IC.  In this study, they looked at the different types and levels of cytokines that appear in the urine of rats with irritated bladders.  Cytokines are proteins often produced in the inflammatory process by immune system cells.  The team looked at levels of 14 different cytokines and found that all of them changed when bladders were irritated, with most going up and one dramatically going down.  Bladder tissue showed the inflammation that the urine cytokines hinted at, and levels of cytokines in tissue, too, went up.  The investigators said these results show that more research on cytokines might yield a marker for IC.
  
  

• Symptoms Don't Separate Hunner's from nonHunner's IC
  Braunstein R, Shapiro E, Kaye J, Moldwin R. The Role of Cystoscopy in the Diagnosis of Hunner's Ulcer Disease. J Urol. 2008 Aug 14. [Epub ahead of print]
  Hunner's lesions or ulcers in the bladder are the classic sign of IC that can be seen on the bladder wall during cystoscopy.  For Hunner's IC, the treatment options are different: removing those lesions with cautery or laser can provide great relief.  Some researchers have said it is possible to tell who has the ulcers without doing a cystoscopy with hydrodistention under anesthesia.  If that's correct, then patients who didn't need to wouldn't have to undergo the procedure.  But these researchers couldn't separate the two groups of patients based on symptoms.  The investigators compared symptoms in the records of 86 patients with Hunner's ulcers with symptoms of 137 who had no Hunner's ulcers. Interestingly, the ratios of women to men were very different in the two groups: 6:1 for patients with no Hunner's ulcers and 3:1 for those who had them.  Patients with Hunner's ulcers were much older on average (60) than those without (47), but those with Hunner's ulcers had not had their disease longer.  There were also no significant differences between the groups in their history of having blood in the urine, having some other disease or condition, or in their levels of pain.  Finding out whether you really do have Hunner's ulcers requires a cystoscopy and hydrodistention, the investigators concluded.

Revised October 27, 2009