ICA @ AUA on the Weekend of May 14 & May 15

Urologists got educated on IC and researchers tackled these questions:

    • Does IC Progress?
    • What does IC cost?
    • What are the connections between your nerves, hormones, and more and your bladder lining?
    • How do you diagnose pudendal nerve problems, and what do they have to do with IC?
    • How can we get a better handle on your symptoms, how they change, and what they mean for your treatment?

Washington, 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.

Saturday, May 14, there were hints of important epidemiologic data to come from the Boston Area Community Health (BACH) study of urologic symptoms:

    • The 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.

    • For 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.

    • Among the women with the most definite IC-type symptoms, 89 percent had symptoms ease, 11 percent were the same, and none had symptoms progress.

Sunday, 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.

    • Dr. 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 number.

    • 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.

No 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:

    • The 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.

    • Eighty-six 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.

    • The 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).

    • But it wasn’t just prescriptions that drove IC patients’ healthcare costs higher. They also had significantly higher inpatient, emergency room, and outpatient costs.

This 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.

    • The 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.

    • Stanley 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.

    • There’s 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.

Meanwhile, 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.

We’re 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