Last weekend the ICA joined 300 doctors, including many members of the ICA’s Medical Advisory Board, at the Society for Urodynamics and Female Urology (SUFU) conference in St. Petersburg, FL. With a conference focus on female urology, there were both educational sessions and posters on IC.

Easing pain was the theme of the IC research presented here. From the University of Kentucky, Deborah Erikson, MD’s team reported on research demonstrating that when intravesical lidocaine fails as a treatment, instillation of bupivacaine (Marcaine) can help.

In the next issue of the ICA Update (coming to you soon), an article on topical treatments for pain notes that the Pelvic and Sexual Health Institute in Philadelphia is doing research on intravaginal diazepam (Valium) to ease the pelvic floor muscle dysfunction that contributes to so much pain in IC patients. Now the team at William Beaumont Hospital, led by Ken Peters, MD, is studying it too and finding that nearly three-quarters of the women who used diazepam pills, suppositories, or creams intravaginally felt better and their pain scores went down significantly. The treatment is also safe. Diazepam delivered this way didn’t raise levels in the bloodstream, and only about a third of the patients said they felt a little drowsy. Injection of botulinum toxin A (Botox) into the pelvic floor is also being studied.

New approaches to neuromodulation for pain relief were a hot topic. A pioneer in neurostimulation for pain management, neurosurgeon Giancarlo Barolat, MD, from Denver, Colorado, told attendees about his neurostimulation techniques for intractable pelvic pain. He finds that, to relieve pelvic pain, stimulating a number of sacral nerve roots (S3, S4, and S5) in the sacral canal is better than stimulating only one sacral nerve root through a space in the sacral bone—typically done today for frequency and urgency—or stimulating the spinal cord itself.

Bladder-based treatments for IC also got research attention. Those included new ways to use neurotoxins like botulinum toxin A (Botox). Different forms, such as botulinum neurotoxin C and a new engineered neurotoxin, are being studied as are new ways of delivering them, such as enclosed in tiny bubbles of fat called liposomes, which is being explored by Michael Chancellor, MD, at William Beaumont Hospital. Dr. Chancellor is also looking at delivering antisense oligonucleotides to bladder cells in liposomes. Those therapies can be designed to turn certain genes off. One possibility might be turning off a nerve growth factor gene in bladder cells, which would avoid the whole-body side effects of monoclonal antibodies.

A technique that many IC patients have been using to avoid pain with bladder instillations was confirmed in a more formal study. Robert Moldwin, MD’s team at the Arthur Smith Institute for Urology in New Hyde Park, New York, looked at whether catheter size could make a difference in instillation pain. Patients felt less pain when a 10-Fr catheter was inserted than when a 16-Fr catheter was inserted, even after numbing lidocaine was squirted in the urethra. Pain was also higher when the bigger catheter was taken out, although the difference wasn’t statistically significant.

Even a lunchtime seminar about female sexual dysfunction brought home the message that pain treatment is important. When the moderator asked attendees what was the main reason for their patients’ sexual difficulties, some two-thirds of the doctors answered that it was pain—either pain with intercourse or vulvodynia.

ICA staff disseminated educational materials on IC to several doctors and many expressed their thanks for all the ICA does to help them and their patients. We also met some new doctors and added them to the healthcare provider registry.

Posted March 03, 2010