ICA @ AUA
on the Weekend of May 14 & May 15
got educated on IC and researchers tackled these questions:
does IC cost?
are the connections between your nerves, hormones, and more and your bladder lining?
do you diagnose pudendal nerve problems, and what do they have to do with IC?
can we get a better handle on your symptoms, how they change, and what they
mean for your treatment?
DC—The largest world meeting for urologists, the American Urological Association meeting, has been under way for
only a day here in Washington, and already, there’s news about IC.
May 14, there were hints of important epidemiologic data to come from the
Boston Area Community Health (BACH) study of urologic symptoms:
analysis is showing that with IC, symptoms calm down for many—in fact in about as
many people as they progress. Those who had more symptoms when they were first
surveyed tended to have fewer symptoms when they were followed up.
men with the most definite IC-type symptoms (pain as the bladder fills or pain
with urination for more than three months), about 87 percent had symptoms ease,
about 13 percent stayed the same, and none had symptoms progress.
the women with the most definite IC-type symptoms, 89 percent had symptoms
ease, 11 percent were the same, and none had symptoms progress.
May 15, started off with the first of three courses being given during this
meeting on IC and pelvic pain. The ICA’s own Board and Medical Advisory Board
member Robert Evans, MD, along with well known IC researcher and clinician
Deborah Erickson, MD, taught the course. Urologists and other clinicians there
got a good review of the new AUA guidelines and all the current treatments.
Evans was enthusiastic about the results he has seen with cyclosporine, a drug
that can have serious side effects but is being used at a fairly low dose for
difficult IC cases with some good results. Dr. Evans noted that IC is likely
much more common than we used to think and believes that the number research
will settle on is likely to be on the high side of the current estimate of 4 to
12 million Americans. Of course, only a test can give us a more definite
Dr. Erickson held out hope for a test to come,
reviewing all the efforts being made. A test based on antiproliferative factor
(APF) has been set back by difficulties in getting a strong enough signal to measure that can be done
in a doctor’s office, but she remains enthusiastic about an APF-based test.
surprise to most of you, new data are confirming that the cost of IC is high.
Although a scheduling conflict prevented a study on the costs from being
presented during a scientific session, the researchers’ abstract tells an
interesting story (This study was based on a large research database of
healthcare claims that included 17,604 adults with IC. In the past, studies
were done in just one geographic area and one insurance database.) Researchers found that:
costs of treating IC in the first year were $3,114 higher than for a similar
group of people without IC, $11,067 versus $7,953.
percent of the IC patients were women, which nearly matches the 6 to 1 ratio of
women to men with IC that some studies show. Although estimates go up as high
as 2 to 1 women to men, matching the 6 to 1 ratio means that doctors are
probably doing a better job of diagnosing IC in men, since the estimate used to
be 10 to 1, and at one time, most doctors didn’t even think about an IC
diagnosis for men.
IC patients in this study had more prescriptions filled for nonsteroidal
anti-inflammatory drugs, weak opioids, strong opioids, antidepressants, and
benzodiazepines (muscle relaxants and anti-anxiety agents).
it wasn’t just prescriptions that drove IC patients’ healthcare costs higher.
They also had significantly higher inpatient, emergency room, and outpatient
afternoon, the Society for Infection and Inflammation in Urology met. Many of
its members are the researchers the IC and chronic prostatitis/chronic pelvic
pain communities know well, such as Dr. Evans.
keynote speaker was basic research scientist Lori Birder, PhD, from the
University of Pittsburgh, who spoke about the neurophysiology of the bladder lining.
Connections she and her colleagues have made between injury to spinal nerves
and damage to the lining of the urinary tract kicked off her presentation and
lend some weight to the idea that damaged or malfunctioning nerves in the
pelvis, such as the pudendal nerve, might actually cause some damage to the
bladder lining. That’s an idea we explore in the ICA Update article “Is IC Really on Your Nerves?” in the Spring
2011 issue that is on its way to members right now.
Antolak, Jr, MD, a urologist who treats pudendal nerve problems and who was
quoted in that article, made two poster presentations at this afternoon’s
meeting. One was on his testing methods for pudendal nerve dysfunction or
damage (neuropathy) and the other on the role of nerve blocks—injections of
anesthetics and steroids around the nerve—in treating and diagnosing the
problem. The diagnosis and treatment of pudendal neuropathy has been controversial,
but at this meeting, some IC and CP/CPPS experts said that, yes, they do see
the problem and were making plans to learn more about treatment methods.
so much we still don’t know about the function of the lining of the bladder and
urinary tract, said Dr. Birder, but what she and her colleagues are learning
about the interactions between the urothelium and nerves, sex hormones, blood
vessels, and inflammation could explain many of the symptoms patients and their
doctors see, such as menstrual cycle-related flares, and could produce some
more effective treatments in the not-too-distant future.
IC researchers are getting a better handle on patients’ symptoms by having them
map their body pain and by measuring symptoms with a wristwatch-like device
that lets patients record their voids and pain. By detecting movement, the
device also measures sleep. It will only take a few days of measurements to get
an accurate picture of how patients are doing. This research also highlighted
that sleep disturbance for IC patients is severe. For Dr. Evans, that
reinforced his observation that helping patients get the sleep they need is one
of the most important steps clinicians can take in easing your symptoms.
looking forward to sharing what we learn Monday morning’s sessions with all of
you. This is when most of the new IC research will be presented at two podium
sessions devoted exclusively to IC—a first at this meeting, so stay tuned.
Posted May 16, 2011