IC Receives More Recognition and Research Coverage at this Year’s AUA Annual Meeting

Orlando, FL (May 20, 2008) --- Interstitial cystitis got a lot of attention yesterday at the American Urological Association’s Annual Meeting.

NIH Study Shows Positive Results with Physical Therapy
Scientific validation was given to a treatment that many people with IC have discovered on their own—physical therapy directed at the pelvic floor really helps. The NIH-funded physical therapy pilot study that represented these positive findings was part of the morning’s plenary session as the AUA’s "late-breaking news," signaling its importance. Kenneth Peters, MD, from William Beaumont Hospital in Royal Oak, Michigan, presented the results of the study by the Urologic Pelvic Pain Collaborative Research Network (a collaboration of NIDDK IC and chronic prostatitis/chronic pelvic pain or CP/CPPS researchers).

It’s not easy to put physical therapy to a scientific test because both the therapists and the study participants they treat know the treatment the participants are receiving. But for this study the researchers did pit one type of physical therapy against another—pelvic floor directed therapy against full-body Western style massage. This pilot study included 48 patients, both men and women with IC/painful bladder syndrome (PBS) or CP/CPPS, who had tenderness on a pelvic exam. They were randomly assigned to one type of therapy or the other. The therapists were all experienced in the techniques but also got training and certification to ensure they were delivering the same types of therapy, which patients got for one hour a week over 10 weeks. Only two patients dropped out of the study.

Fifty-seven percent of the patients who got the pelvic floor directed therapy said they were moderately or markedly better compared with 21 percent of patients who got the general massage, a significant difference. But there was another interesting difference between men and women. No women at all said they got better with the general massage treatment, whereas 45 percent of the men did. Among the women alone, 45 percent got help from pelvic floor-directed therapy, and among the men, 67 percent did. The reason for this gender difference isn’t clear. It could be that men and women respond differently to therapeutic touch or that the two syndromes respond differently.

Although the researchers hope to do a larger trial, Dr. Peters said that these results show pelvic floor physical therapy is a "clinically meaningful treatment option."

IC and Pelvic Pain Syndrome Receive State-of-the-Art Lecture
Also very significant at yesterday's plenary session was that IC and also pelvic pain syndrome in women were subjects of a “state-of-the-art” lecture. This signals that urologists have recognized that IC is not only a real condition but also that it is an important part of urology practice, that urologists need to keep learning about IC to help their patients more effectively, and that IC is an important and active field of urologic research.

Philippe Zimmern, MD, from the University of Texas Southwestern Medical Center, gave this lecture, emphasizing that the topic is receiving more attention than ever and that urologists need to take time to listen to patients and carefully exclude other conditions that produce IC-like symptoms. He noted that pelvic pain syndrome in women is still being defined, and he urged all of his interested colleagues to attend the NIDDK meeting next month in Bethesda, Maryland, that will help define it (please click here for meeting details). He described the typical symptoms and told his colleagues what to look for, including myofascial trigger points.

The main question, he said, is whether the disease is urologic (in the bladder) or not, but he emphasized that it’s both. He also recommended that when the problem doesn’t seem to be bladder based that urologists refer patients to pelvic floor specialists and consider pain management. He also told his colleagues that patients frequently have nonurologic conditions and that urologists need to find other specialists for their patients and coordinate their care.

More on the Research Front
During Monday afternoon, a session with more basic research hinted at mechanisms of IC pain and future treatments. An animal study from Japan suggested that estrogen deficiency prompts sensitization of nerve fibers that then make the bladder hypersensitive. Adding back estrogen, but not progesterone, alleviated the hypersensitivity. In addition, a drug that blocks a certain kind of serotonin receptor appears to increase bladder capacity. Researchers working with Michael Chancellor, MD, have continued their research on the marijuana-like drugs (cannabinoids) encapsulated in liposomes. Now, they are looking at drugs that are much more specific for a certain type of cannabinoid receptor. This more targeted agent helped reduce bladder spasms and pain in response to irritation. There are no human trials so far of the cannabinoids in liposomes or the liposomes themselves, but we look forward to those studies.

You’ll be able to read more about these studies in detail in our special report on the 2008 AUA Annual Meeting.