This Year's AUA Annual Meeting Brings IC to the Forefront and Announces Plans to Keep it There
Orlando, FL (May 22, 2008) --- On Wednesday, discussion of research funding, drug safety, and education all had implications for IC:
NIDDK Unveils Plans to Revitalize Urology Research
Robert Star, MD, Director of the Division of Kidney, Urologic and Hematologic Diseases for NIDDK, spoke to urologists about the institute’s plans to give urologic research a major infusion and highlighted the new Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) program as a major step in that effort. The innovative MAPP program will be focusing on the study of interstitial cystitis/painful bladder syndrome (IC/PBS) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and their relationship to other known comorbid conditions such as irritable bowel syndrome (IBS) and fibromyalgia. In Dr. Star’s plenary session presentation, “Advancing Urologic Research and Career Development,” he pointed out that because the burden of urologic disease in this country is high—costing some $11 billion a year—and because so many urologic conditions are chronic, difficult to define, and hard to treat, urology can’t fall behind in research and training. But it has, and the NIDDK aims to change that.
Experienced researchers have, in fact, been leaving urology and younger researchers are not coming in at the needed rate. That’s why the institute has revamped its O’Brien Urology Centers for research so that the centers focus on one key urologic problem that hasn’t had the research progress that it needs. The institute also plans to foster collaboration between those researchers and others from different fields who can bring new perspectives and expertise that may spur the needed leaps in progress. The NIDDK has also developed a program called the Multidisciplinary K12 Urologic Research Career Development Program to cultivate and mentor new, successful urology researchers. The cooperative NIH-AUA Surgeon-Scientist awards will also continue to develop urology researchers’ careers.
Dr. Star noted that years of studies on IC/PBS and CP/CPPS have not yielded the needed advances, and the NIDDK hopes that this support of not just urology research but also cross-disciplinary research will bring effective diagnostic, treatment, and prevention tools.
US Food and Drug Administration Announces Plans to Improve Drug Safety
Also addressing a large audience at the plenary session was FDA Commissioner Andrew von Eschenbach, MD, who talked about changes being made at the FDA to streamline approvals and improve drug safety. Prompted in part by the contamination of Chinese-produced heparin that harmed some IC patients who used it in instillations, the agency will set up FDA inspection offices around the world, including China, India, the Middle East, Latin America, and Europe.
ICA Medical Advisory Board Member Provides Practical IC Training Course
By Wednesday afternoon this year’s AUA annual meeting was winding down, but the crowd wasn’t thin at the IC course taught by Robert Moldwin, MD. Some 80 urologists attended this session that Dr. Moldwin packed with practical information about helpful treatments. Dr. Moldwin, who is a member of the ICA’s Medical Advisory Board, has been a pioneer in the use of anesthetic instillations to see if the bladder is the source of pain and he also uses them for treatment. Examine your patients and listen to them, he emphasized, noting that really listening to patients’ descriptions of their pain and symptoms are keys to diagnosis and treatment. He did urge his colleagues to be sure that patients don’t have other sources of their pain, such as pelvic congestion syndrome, fistulas, or even bladder stones.
Treatment of IC starts with diet and what he called the “big three” that patients are so familiar with—amitriptyline (Elavil), pentosan polysulfate (Elmiron), and hydroxyzine (Atarax). He also pointed out that various therapies for associated conditions are helpful for IC as well as more global therapies, such as opioids, serotonin-norepinephrine reuptake inhibitors (SNRIs), and antiseizure medications, such as gabapentin (Neurontin) and pregabalin (Lyrica). Twice he noted that part of getting patients on track with treatment included referring them to the ICA for help.
He also emphasized diagnosis and treatment of pelvic floor dysfunction. Warm baths, physical therapy, trigger point injections, and diazepam (Valium) in small doses spread over the day, and even diazepam suppositories are all therapies that help relax muscles that contribute to pain, he said. Dr. Moldwin is also an out-of-the-box thinker when it comes to searching for helpful treatments, and he mentioned that amitriptyline in a cream around the urethra helped one patient who had terrible pain after urination and got no help from many other treatments.
He gave his colleagues tips on the best ways to fulgurate or laser Hunner’s ulcers; information about latest research on botulinum toxin (Botox); the latest thinking about the use of hydrodistention and neuromodulation; and the best approaches to the last resort option—surgery.
Recognizing that he is clearly one of the best in the business, Dr. Moldwin’s colleagues kept him long past the end of the course time to get advice on treating their own patients. Thanks to him and all the IC experts who gave courses, chaired sessions, presented studies, and shared their perspectives, all of us will have more and better trained doctors who can really help.
Our appreciation and congratulations to everyone involved in helping to make the 2008 American Urological Association Annual Meeting an unprecedented success!