Orlando, FL (May 19, 2008) - On Sunday at the American Urological Association Annual Meeting in Orlando, Florida, we heard the first good clinical trial news for people with IC in a long, long time. A randomized, placebo controlled study proved the value of instillations with alkalinized lidocaine. Curtis Nickel, MD, from Queens University in Kingston, Ontario, who presented the results, said it was his first opportunity in decades to present a positive study with the power to show the benefits they hoped to achieve. Many people with IC already get instillations for flares, and instillations with lidocaine or other anesthetics have become very popular, much more so than DMSO.
But not all physicians instill anesthetics with bicarbonate, which makes the bladder contents alkaline rather than acidic. That helps the lidocaine get absorbed, as previous research has shown. In this trial, it became apparent that, not only are lidocaine-bicarbonate instillations helpful for flare ups, they may also be valuable, and even more effective, used long-term—and for patients who are the worst off. Those who didn’t get helped by other treatments got five days of the therapy and were followed up 8 and 15 days later. If they said they were moderately or markedly better, that was considered a response.
On day eight, 30% had a response, and 24% did on day 15. In contrast, only 10 percent of patients who got placebo said they had a response on day 8 and 12 percent on day 15. After that, patients who wanted another five days of actual treatment could get it, and 85 percent of them did. The response rate went up to a whopping 65%.
Dr. Nickel said that this study also implies that this instillation could be used to judge whether a patient’s pain is coming from their bladder.
Robert Moldwin, MD, of Long Island Jewish Medical Center, has long been using anesthetic instillations for that purpose instead of the potassium sensitivity test, and he has also promoted use of anesthetic instillations for treatment. At the IC podium session, he presented a study of urodynamic evaluations of patients who got lidocaine instillations, which showed in a concrete way how helpful this treatment is. Bladder capacity, the maximum rate of urine flow, and the amount of fluid a patient could hold before feeling the need to void all went up significantly.
Instillations of lidocaine, bicarbonate, and heparin were also used in a study showing that easing pain this way can also improve many IC patients’ sex lives. Half of the patients who got instillations could then have comfortable intercourse, but that good effect was much more common in patients who had bladder tenderness alone (in 81 percent) than in patients who had tenderness in more areas (19%). Patients who had just bladder tenderness also had significant improvements in desire, arousal, orgasm, satisfaction, and pain.
The IC session also had important news on detecting IC. Tony Buffington, DVM, MS, PhD from The Ohio State University in Columbus, Ohio, used an infrared microscope to look at samples of blood from both people and cats with IC and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and compared the patterns of infrared light transmission from them with those from healthy people and cats. The patterns were very consistent and predicted who had IC or CP/CPPS with an amazing 100% accuracy. More research needs to be done to make comparisons with other diseases and to find the markers that these wavelengths may indicate, but this looks like a promising—maybe even surefire—way to detect IC or CP/CPPS.
Tomohiro Ueda, MD, from Kyoto, Japan, has found a way to see Hunner’s lesions and areas abnormally rich in blood vessels with a cystoscope without having to do hydrodistention. The cystoscope has an imaging system that filters certain wavelengths of light making these bladder abnormalities easier to see. The patients he studied also underwent conventional cystoscopy with hydrodistention. The cystoscope showed all the Hunner’s patches that could be seen conventionally and the capillary rich areas that produced glomerulations during hydrodistention. These areas in the IC bladder also produced more of a blood vessel growth factor than other areas of the bladder.
More basic research presented on Sunday also aimed toward future treatments and to explaining the IC process. The liposomes (fat globules) that are under investigation as a potential IC treatment were shown to stay in the bladder for a long time, which should be helpful for treatment. Other researchers are looking at more ways to get bladder cells to produce their own painkillers.
It is known that neural “crosstalk” can occur between the colon and the bladder, which helps explain why irritable bowel syndrome (IBS) often goes along with IC. Now information is being presented about how that connection might affect the bladder. Irritation of the colon prompted mast cells to migrate to the bladder and also prompted breakdown of the bladder lining. Mast cells were also fingered as culprits in bladder pain. You’ll be able to read more about all of these studies in our upcoming special report on the AUA annual meeting.
Sunday’s presentations brought more good news for people with IC than we have heard in some time. Stay tuned for more good news coming soon!