IC research has answered many questions, but not all
Anonymous User
December 1, 2001
By: Philip M. Hanno, MD
Urology Times
This is an exciting time to be involved with interstitial cystitis, from the
clinical aspect of caring for patients, to the search for markers and better
methods of diagnosis, to the basic research so critical in ultimately finding
etiologies and a cure.
The articles in this month's Urology Times help to underscore these issues (see
page 8). Tomohiro Ueda, MD, PhD, and colleagues have identified a cytokine
inhibitor that seems to improve interstitial cystitis symptoms and increase
bladder capacity, according to a preliminary trial in patients with
non-ulcerative disease. The potassium chloride test study of Tony Yen-Huang
Chen, MD, would appear to limit the usefulness of this potentially painful
examination as a diagnostic adjunct. The profile that Frederic Liandier, MD,
did of 287 IC patients serves to confirm that while we have many therapies for
this disorder, nothing works for everyone and the treatment of IC is as much
art as it is science-perhaps more so.
Among many epidemiologic issues, two urgently need to be addressed by
appropriate studies. Although classically, only 10% of interstitial cystitis
occurs in men, the hallmark symptoms of chronic prostatitis-pelvic pain,
voiding dysfunction, and pain associated with sexual activity-overlap with
those in men who carry an IC diagnosis.
We have little knowledge of whether children suffer from interstitial cystitis,
how common it is in young age groups, how it presents, and what the natural
history is. Apart from a few anecdotal series in the literature, this is
largely virgin territory. Frequency and urgency in childhood is certainly not
unknown, but its relationship to IC remains a mystery.
With regard to diagnosis, undue reliance on cystoscopic criteria and the
National Institutes of Health research criteria has undoubtedly resulted in
underdiagnosis of the syndrome. For now, the clinical diagnosis of IC is still
an "Aunt Minnie." You know it when you see it, but it is hard to describe with
any clarity.
The continuing problems with diagnosis highlight the importance of the search
for markers. Markers should help us understand the etiology and pathophysiology
of IC, enable us to make a definitive diagnosis in the face of competing
potential etiologies, allow for a more rational treatment algorithm, help us
reassure the patient with regard to long-term prognosis, and become an
adjunctive measure in following the clinical course of the disease.
In a field with limited placebo-controlled, multicenter clinical therapeutic
trials available to judge therapies, we can look forward to results from two
NIH efforts. Just completed and awaiting analysis is the study of pentosan
polysulfate sodium (Elmiron), hydroxyzine hydrochloride (Atarax, Vistaril), and
combination therapy versus placebo. Just beginning is the first multicenter
trial of intravesical bacille Calmette-Guérin ([BCG] Pacis, TheraCys, TICE BCG)
versus placebo.