ICA @ SUFU 4U
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